An analysis of demographic and pregnancy outcome data to explain non-attendance for postpartum glucose testing in women with gestational diabetes mellitus

Abstract

Objectives To identify significant differences in the demographic and pregnancy factors for women with gestational diabetes mellitus who attended or failed to attend for postpartum glucose testing. Study design A database of 1052 patients with gestational diabetes mellitus was reviewed. The sample was divided into those who attended for postpartum glucose testing and those who did not. Demographic and obstetric outcomes for the two groups were compared. Results Seventy-four per cent of patients who did not attend for postpartum glucose testing were in the two most deprived quintiles. Smokers, unemployed, younger women, those of higher parity and those who did not breast feed were less likely to attend. Conclusions Failure to attend for postpartum glucose testing is associated with demographic factors reflective of deprivation. The opportunity to afford lifestyle changes and diabetes screening in these groups of women has been missed. Targeted patient education and accessible postpartum testing may improve compliance.

Persistência Hiperglicêmica No Pós Parto

“…A maioria dos participantes dos estudos foram mulheres que apresentaram hiperglicemia durante o período gestacional 4,5,6,7 ou receberam diagnóstico de diabetes mellitus gestacional, 8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31 sendo que em apenas dois 32,30 dos estudos, foi avaliado também pacientes sem essas condições, a título de comparação. Alguns estudos mostraram a importância de se utilizar mais de um exame laboratorial como forma de diagnosticar hiperglicemia e diabetes mellitus gestacional.…”

“…14 Ainda sobre o acompanhamento da glicemia, um artigo identificou que os fatores demográficos são importantes, sendo que pacientes mais carentes, fumantes, desempregados, mais jovens e que não amamentaram compareceram menos ao exame pós-parto. 15 Quanto à influência da história familiar, um estudo encontrou que mulheres que desenvolveram hiperglicemia pós-parto provavelmente tinham uma história familiar de diabetes mellitus, 10 o que concorda com uma coorte prospectiva, onde o antecedente Além disso, a sua prevalência é maior em mulheres negras não hispânicas e hispânicas. 13,14 Sobre a persistência hiperglicêmica no pós parto, foi demonstrado que a hiperglicemia durante a gravidez está relacionada a anormalidades glicêmicas no pósparto, nas quais valores mais altos no TOTG para 75 g e os exames de medição de glicose após 2 horas de jejum durante a gestação são fatores de risco para a hiperglicemia pósparto, e níveis elevados de HbA1c durante a gravidez é relacionado como fator de risco para metabolismo anormal de glicose, 4,9,10, 12,16,17,19 assim como os níveis elevados de triglicerídeos.…”

Strategies to improve postpartum engagement in healthcare after high-risk conditions diagnosed in pregnancy: a narrative review

“…Race and ethnicity: Black individuals [ 37 , 40 ] in U.S.; individuals of Eastern European and Caribbean race and ethnicity in U.K. [ 47 ]; individuals of Indigenous background in Australia [ 43 ]…”

“…Many of the identified barriers are frequently associated with worse health outcomes across the life course, and often co-exist with each other. For example, people with GDM of high socioeconomic status are more easily able to overcome financial barriers to undergoing oral glucose tolerance testing [ 53 ], and those who live rurally [ 52 ], or in an area of deprivation [ 47 ], are more likely to experience barriers to uptake of testing. Black and Hispanic individuals are over-represented among people with the diagnosis of GDM and HDP [ 54 ] yet have lower rates of uptake of postpartum testing [ 55 ].…”

“…For many, the logistics of attending for testing present barriers, for example accessibility issues for those requiring childcare and breastfeeding facilities [ 49 ], and the time involved in undergoing an OGTT [ 50 ]. There is conflicting data on the relationship between undergoing postpartum testing, and factors such as maternal age [ 28 , 36 , 37 , 40 , 42 , 47 ], requirement for insulin for GDM management [ 36 , 46 , 47 , 56 ], and the timing of first presentation for antepartum care [ 37 , 51 ].…”