Barriers to postpartum follow-up of mothers with gestational diabetes mellitus and its implications: a mixed method study

Abstract

Aims To explore the barriers that reduce postpartum follow-up of mothers with gestational diabetes mellitus. Settings and design This is a mixed method study with a qualitative study followed by a detailed narrative review conducted in Karnataka. The subjects were selected from Dr. T M A Pai Rotary Hospital, Karkala. Methods and material A total of 6 in-depth interviews were conducted out of 9 patients who met the inclusion and exclusion criteria. The contact number of the patients was obtained and they were contacted over the phone. Interviews were conducted at a place and time of the women's choice. Narrative review Thematic analysis approach was used for analysis. The codes were formed from the transcripts and then categories were formed. A narrative review was also conducted to explore the existing evidence on the topic. In total, 62 articles were reviewed including various types of studies. Results The key findings are categorized in general as barriers, then subthemes were formed. The most common barriers were lack of prior appointment for mothers, lack of adequate hospital facilities, baby and concerns, priority and lack of knowledge or health education. Conclusions The overall study findings reveal that healthcare facilities must be strengthened to avoid long waiting time and overcrowding to improve the screening after delivery. Educating the women regarding the need for dietary restrictions and exercise and giving priority to their own health as well as reminder systems is necessary to ensure the postpartum follow-up. Keywords Barriers. Postpartum follow-up. Gestational diabetes mellitus Key messages Given the evidence of gestational diabetes mellitus and its progression to type 2 diabetes mellitus, we have to promote postpartum follow-up.

Barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior gestational diabetes: A systematic review and qualitative synthesis applying the theoretical domains framework

“… 71 Some were deterred by the presence of ‘strong built people’ 66 in exercise facilities, preferring a ‘private place to exercise away from men’. 69 Other barriers included issues with appointment scheduling, 68 , 76 , 81 , 88 lack of childcare and breastfeeding facilities, 61 , 64 , 84 limited or inflexible opening hours, 71 , 79 , 88 long waiting times 62 , 65 , 84 , 87 , 88 , 89 and test duration. 62 , 65 , 68 , 89 …”

“… 74 This enabled prioritisation of follow‐up when HCPs stressed their future T2D risk and the importance of healthy behaviours. 61 , 62 , 63 , 64 , 65 , 73 , 74 , 75 , 78 , 79 , 86 , 87 , 88 , 89 Lack of information provision was a barrier. Many women reported that HCPs did not inform them about their risk of T2DM 62 , 65 , 68 , 74 , 84 , 89 :or strategies to support T2DM prevention 67 , 71 , 81 , 91 : ‘The breastfeeding helps control blood sugar …?…”

“…71 Some were deterred by the presence of 'strong built people' 66 in exercise facilities, preferring a 'private place to exercise away from men'. 69 Other barriers included issues with appointment scheduling, 68,76,81,88 lack of childcare and breastfeeding facilities, 61,64,84 limited or inflexible opening hours, 71,79,88 long waiting times 62,65,84,[87][88][89] and test duration. 62,65,68,89 Social Influences (32 studies; 47 barriers, 38 enablers) Information regarding future risks or healthy behaviour recommendations provided by HCPs were important enablers, as were pragmatic or emotional support from family and friends.…”

“…75 The communities also supported physical activities by 'painting these in a positive light'. 75 Conversely, some women reported little pragmatic support 62,65,73,76,84,85,88,89 or encouragement 68,72,75,77,85,86,88 : 'They have their own ways of doing things, and it kind of gets handed down to us, and it's hard to change'. 93 Migrant women, customarily supported by female relatives in the postpartum period in their home country, reported that their engagement in healthy behaviours was impaired by lack of support at home, and feelings of isolation and loneliness.…”

Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A systematic review update and qualitative synthesis applying the Theoretical Domains Framework

“…70 Conversely, women interpreted 'normal' results from pre-discharge blood tests and home-based monitoring to mean that they were no longer impacted by gestational diabetes, citing it as a key reason for not participating in type 2 diabetes screening. 71 Some authors highlighted anticipated regret at not screening for type 2 diabetes: 'One of the women said that she was aware of the consequences of failing to undergo screening and often worried about it' 61 but many studies cited experience of the 'bloody brutal' 57 OGTT test during pregnancy as a major barrier. 48,53,62 Social/Professional Role and Identity (10 studies; 12 barriers, 0 enablers)…”