Implementing a Reminder System in the Northern Part of Belgium to Stimulate Postpartum Screening for Glucose Intolerance in Women with Gestational Diabetes: The “Sweet Pregnancy” Project

Abstract

Aims To evaluate the feasibility and efficacy of a gestational diabetes (GDM) recall register on the long-term screening uptake postpartum and to evaluate the prevalence of prediabetes postpartum. Methods Evaluation of a GDM recall register implemented in 66 obstetrical centers in the northern part of Belgium from 2009 to 2016. Registrants receive yearly reminders to have a fasting plasma glucose test in primary care to timely detect prediabetes. Results After 6 years, 7269 women were registered. The yearly response rates varied from 74.4% after the first year to 61.8% after the fifth year. The number of women who reported a screening test varied from 67.4% after the first year to 71.9% after the fifth year. Compared to women who responded at least once to a reminder, women who never responded were more often <30 years (41.4% versus 33.9%, p < 0.001) and were more often obese (29.3% versus 20.8%, p ≤ 0.001). Over a period of 6 years, 7.3% (CI 6.0%–8.8%) developed diabetes and 27.4% (CI 23.9%–31.0%) developed impaired fasting glycaemia. Conclusion We show now the long-term feasibility and efficacy of a GDM recall register to stimulate screening postpartum. One-third of women developed prediabetes within 6 years.

Improving Uptake of Postnatal Checking of Blood Glucose in Women Who Had Gestational Diabetes Mellitus in Universal Healthcare Settings: A Systematic Review

“…Five primary studies [25,26,27,28,29] and 2 systematic reviews [9,24] reported on the barriers that would reduce the likelihood of a woman attending postnatal screening for T2DM, which included the OGTT itself, demands on maternal time, lack of knowledge, risk perception and knowledge of the relevant health professionals. Suggestions to increase uptake were reported in 10 primary studies [25,26,27,28,29,30,31,32,33,34,35] and 2 systematic reviews [9,23]. The key suggestion that was reported by 8 primary studies [26,27,28,29,30,31,32,33,35] and 1 systematic review [23] was the use of reminder systems.…”

“…Suggestions to increase uptake were reported in 10 primary studies [25,26,27,28,29,30,31,32,33,34,35] and 2 systematic reviews [9,23]. The key suggestion that was reported by 8 primary studies [26,27,28,29,30,31,32,33,35] and 1 systematic review [23] was the use of reminder systems. Other suggestions included effective education and information and a shorter test duration.…”

“…Women with GDM expressed their desire for a more palatable quicker test [24]. Although not described formally as a barrier, Benhalima et al [30] stated that the fasting plasma glucose test was used rather than OGTT because it was more practical and achievable.…”

“…Van Ryswyk et al [30] found that 15% of women with GDM did not believe that they were at high risk of T2DM, and so did not have the test, although another 15% who were concerned they were at high risk also did not have the test. Conversely, Sterne et al [26] found that only 1% of women with GDM stated fear as a barrier to screening, whilst 15% of women who had had GDM found fear of T2DM increased uptake of postnatal screening.…”

“…Reminder systems were the most frequently suggested intervention to improve screening. In a large Belgian study, 5465 women were included in a register which sent automated letters and emails 3 months after delivery and then subsequent reminders for up to 6 years to those who had not yet undertaken the screening test [30]. All the women had voluntarily enrolled in the register after a diagnosis of GDM, and response rates for the screening tests postpartum ranged from 67.4% after the first year to 71.9% after the fifth year.…”