Post-partum follow-up of women with gestational diabetes mellitus: effectiveness, determinants, and barriers

Aziz, Saleha; Munim, Tazeen Fatima; Fatima, Syeda Sadia

doi:10.1080/14767058.2017.1321630

Cited by 21 publications

(15 citation statements)

References 21 publications

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“…The investigation of obstacles to ppOGTT indicated that a prominent barrier was represented by a competing priority, that is newborn care. This data is consistent with other reports and, interestingly, it is common to any examined population [18,34,35]. In addition, it is worth noting that the priority towards the newborn constitutes a prevailing barrier even in women treated with insulin during pregnancy, a category that generally demonstrates a stronger compliance for ppOGTT.…”

Section: Discussionsupporting

confidence: 91%

“…However, despite compelling lines of evidence demonstrating the relevance of postpartum screening among women with previous GDM and the increased risk for non-adherent women in developing T2DM later in life, the rate of GDM women receiving appropriately-timed postnatal glucose testing is quite low [11]. Several explanations have emerged for the non-attendance of women for ppOGTT after GDM [13,14,15,16,17,18]. They include patient subjective barriers, such as newborn care, travel and socioeconomic difficulties, the lack of interest for healthcare, the lack of family support, the lack of understanding about the T2D risk and test discomfort [19].…”

Section: Introductionmentioning

confidence: 99%

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Barriers to Postpartum Glucose Intolerance Screening in an Italian Population

Quaresima

Visconti

Chiefari

et al. 2018

IJERPH

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Background: Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus (T2D) and the postpartum period is crucial for early treatment in at-risk women. However, despite recommendations, only a fraction of women undergo a postpartum screening for glucose intolerance (ppOGTT). The present study aims to verify the reason(s) for poor adherence in our population. Research design and methods: This retrospective study includes 451 women in which GDM was diagnosed between 2015–2016. During 2017, we verified by phone interview how many women underwent ppOGTT at 6–12 weeks postpartum, as recommended by the Italian guidelines. The non-compliant women were asked about the reason(s) for failing to screen. The non-parametric Mann-Whitney test and the 2-tailed Fisher exact test were used to compare continuous and categorical features, respectively, among women performing or non-performing ppOGTT. Results: Out of 451 women with GDM diagnosis, we recorded information from 327. Only 97 (29.7%) performed ppOGTT. The remaining 230 women (70.3%) provided the following explanation for non-compliance: (1) newborn care (30.4%); (2) misunderstood importance (28.3%); (3) oversight (13.0%); (4) unavailability of test reservation in the nearest centers (10.4%); (5) normal glycemic values at delivery (8.3%); (6) discouragement by primary care physician (5.6%). Conclusions: In our population, most women with recent GDM failed to perform ppOGTT. Our results indicated that the prominent barriers could potentially be overcome.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Barriers to Postpartum Glucose Intolerance Screening in an Italian Population

Quaresima

Visconti

Chiefari

et al. 2018

IJERPH

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“…Similar to our findings, a positive association between GDM history, 2-hour glucose; and HbA1c during pregnancy and post-partum diabetes was seen within Chinese women [32]. Interestingly, in a recent study conducted by our group, we found that 14% of GDM positive females developed DM within 2 years of their last pregnancies [33]. Furthermore, we report a higher birth weight as well as infant weight 6 weeks post birth for GDM mothers.…”

Section: Discussionsupporting

confidence: 90%

Colostrum and mature breast milk analysis of serum irisin and sterol regulatory element-binding proteins-1c in gestational diabetes mellitus

Fatima

Khalid

Ladak

et al. 2018

The Journal of Maternal-Fetal & Neonatal Medicine

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“…The 20 studies included in this systematic review and meta-analysis had differing lengths of follow-up, time of screening, ethnic origin of study participants, and diagnostic criteria for both GDM and T2DM 2728313334353637383940414243444546474849. All studies were observational, seven were described as prospective cohorts, six as retrospective cohorts, four as population based studies, two as follow-up studies, and one as a hospital based study.…”

Section: Resultsmentioning

confidence: 99%

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

Vounzoulaki

Khunti

Abner

et al. 2020

BMJ

697

476

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ObjectiveTo estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls.DesignSystematic review and meta-analysis.Data sourcesMedline and Embase between January 2000 and December 2019, studies published in English and conducted on humans.Eligibility criteria for selecting studiesObservational studies investigating progression to T2DM. Inclusion criteria were postpartum follow-up for at least 12 months, incident physician based diagnosis of diabetes, T2DM reported as a separate outcome rather than combined with impaired fasting glucose or impaired glucose tolerance, and studies with both a group of patients with GDM and a control group.ResultsThis meta-analysis of 20 studies assessed a total of 1 332 373 individuals (67 956 women with GDM and 1 264 417 controls). Data were pooled by random effects meta-analysis models, and heterogeneity was assessed by use of the I2 statistic. The pooled relative risk for the incidence of T2DM between participants with GDM and controls was estimated. Reasons for heterogeneity between studies were investigated by prespecified subgroup and meta-regression analyses. Publication bias was assessed by funnel plots and, overall, studies were deemed to have a low risk of bias (P=0.58 and P=0.90). The overall relative risk for T2DM was almost 10 times higher in women with previous GDM than in healthy controls (9.51, 95% confidence interval 7.14 to 12.67, P<0.001). In populations of women with previous GDM, the cumulative incidence of T2DM was 16.46% (95% confidence interval 16.16% to 16.77%) in women of mixed ethnicity, 15.58% (13.30% to 17.86%) in a predominantly non-white population, and 9.91% (9.39% to 10.42%) in a white population. These differences were not statistically significant between subgroups (white v mixed populations, P=0.26; white v non-white populations, P=0.54). Meta-regression analyses showed that the study effect size was not significantly associated with mean study age, body mass index, publication year, and length of follow-up.ConclusionsWomen with a history of GDM appear to have a nearly 10-fold higher risk of developing T2DM than those with a normoglycaemic pregnancy. The magnitude of this risk highlights the importance of intervening to prevent the onset of T2DM, particularly in the early years after pregnancy.Systematic review registrationPROSPERO CRD42019123079.

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Post-partum follow-up of women with gestational diabetes mellitus: effectiveness, determinants, and barriers

Abstract: The high incidence of T2DM in women with previous GDM is an alarming finding. Given this trend, systematic follow-up programs are needed to reduce obesity and diabetes risk.

Cited by 21 publications

References 21 publications

Barriers to Postpartum Glucose Intolerance Screening in an Italian Population

Barriers to Postpartum Glucose Intolerance Screening in an Italian Population

Colostrum and mature breast milk analysis of serum irisin and sterol regulatory element-binding proteins-1c in gestational diabetes mellitus

Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis

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