Preventive Counseling Among Women With Histories of Gestational Diabetes Mellitus

Abstract

OBJECTIVE -The purpose of this study was to examine the association between recall of recommendations for diabetes prevention and both health behaviors and screening among women with histories of gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -We surveyed 228 women with histories of GDM within the past 5 years who were enrolled in a university-affiliated managed care plan. In a cross-sectional analysis, we assessed the association between recall of health care provider advice and both postpartum lifestyle behaviors and reported performance of postpartum diabetes screening. Multivariate models were constructed that adjusted for correlates of counseling including postpartum diabetes, dyslipidemia, insulin use during pregnancy, and provider type.RESULTS -Participants were predominantly non-Hispanic white, college educated and affluent, and overweight or obese. The majority reported that they received counseling on lifestyle modification and postpartum diabetes screening. Postpartum physical activity levels, fruit and vegetable intake, and screening were suboptimal. No significant association existed between recall of advice and physical activity or between recall of advice and diet. Recall of advice along with distribution of laboratory slips for glucose testing was associated with performance of postpartum diabetes screening using self-report (adjusted odds ratio 2.07 [95% CI 1.51-2.84]) or claims data (1.64 [1.16 -2.32]).CONCLUSIONS -Women with histories of GDM who recalled advice regarding postpartum glucose testing and received laboratory slips were significantly more likely to report having had postpartum diabetes screening. Although women's recall of services may not reflect the actual services received, simple counseling may not be sufficient to optimize postpartum behaviors to reduce future risk of diabetes. Diabetes Care 30:2489-2495, 2007G estational diabetes mellitus (GDM) is defined as glucose intolerance first identified during pregnancy (1,2). Although glucose intolerance resolves with delivery ϳ90% of the time (3), women with GDM have an increased risk for future glucose intolerance (4,5). Unfortunately, studies to date suggest that women with GDM may not be informed about the implications of their diagnosis, including how to reduce their future risk of diabetes or about the advantages of lifestyle modification (6,7). Also, although guidelines recommend postpartum testing for glucose intolerance with an oral glucose tolerance test (OGTT) at 6 weeks and an OGTT or fasting glucose periodically thereafter (1,2), many women with GDM do not undergo this postpartum diabetes screening (8 -10).Several studies suggest that physician practices may contribute to these deficits. A 1998 survey of academic obstetriciangynecologists found that only 62% believed that women with GDM were at risk for future diabetes after delivery and only 60% stated they practiced postpartum diabetes screening (11). A 2004 survey of a similar population noted that 75% practiced postpartum screening. No reports have e...

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