Postpartum opportunistic advice in primary care for women who have had gestational diabetes: a qualitative study of health care professionals’ views

Abstract

Background Women who have had gestational diabetes during pregnancy are at very high risk of developing type 2 diabetes later in life, but their understanding of the risks is often limited. In this study we explored the views of health care professionals regarding offering brief opportunistic advice to women after their pregnancy, during unrelated consultations in primary care, relating to reducing diabetes risk. Methods The study took place in three Health Boards in Scotland. We conducted semi-structured one-to-one interviews (either face-to-face or telephone) with two health visitors, three practice nurses, two GPs, two diabetes consultants and two obstetricians. A focus group with five health visitors was also held. A topic guide was followed, covering the feasibility and acceptability of delivering brief opportunistic advice during a routine consultation, the optimal way to identify and recall women with previous gestational diabetes, and the possible content and timing of any such intervention. A thematic approach was used to analyse the qualitative data generated. Results The interviews/discussion lasted from 15 to 51 min. There was widespread support from all participants for offering opportunistic advice, and general consensus that health visitors would be best placed to do this as part of the Universal Health Visiting Pathway in Scotland. Thematic analysis generated three significant points of discussion: implications for training of health visitors, the need for a systematic approach to identifying women with gestational diabetes, and the optimal timing of delivery. Despite an already demanding schedule of providing advice and education to women, health visitors were confident that they could offer educational advice, provided that they received appropriate training to do so. However, there would need to be a watertight system for identifying women in their care who had had gestational diabetes. In terms of timing, later visits around 6–8 months after delivery were considered most suitable. Conclusions There is support from health care professionals, and most pertinently from health visitors, that the frequency of routine visits with women during the Universal Health Visiting Pathway programme in Scotland provides potential opportunities for education around future diabetes risk to women who have had gestational diabetes.

Updates on Gestational Diabetes

“…In Scotland, most women receive health care from the National Health Service (NHS), which is funded by the government. 3 Women who are diagnosed with GDM are referred to their family doctor after delivery for a 13week glycated hemoglobin test, although initially not all women attend. Then, 11 home visits are scheduled ( Universal Health Visiting Pathway ), eight in the first year of life and three between 13 months and 3 to 5 years.…”

“…Then, 11 home visits are scheduled ( Universal Health Visiting Pathway ), eight in the first year of life and three between 13 months and 3 to 5 years. 3 Evans et al 3 in order to evaluate this model of postpartum follow-up, carried out a study in Scotland through interviews with two health visitors, three nurses, two general practitioners, two diabetes consultants and two obstetricians. The results showed broad support from all participants and general consensus that these visitors would be key.…”

“…Women with GDM are at increased risk of cardiovascular events, and their children are predisposed to the future risk of obesity and T2DM. 2,4,5 Evan et al 3 recently concluded, in qualitative research, that there are perceptions around GDM that, if not addressed, are likely to compromise the effect of lifestyle interventions. For example, although many women know that there is an association between GDM and T2D in their future, they may not understand this risk as GDM has minimal and transient impact on their lives.…”

“…If it's short-lived and easily controllable, they often don't realize the potential consequences. The authors also hold health professionals accountable, accepting it as a fact without consequences, and creating "postpartum abandonment" 3 In normal pregnancy, the placenta produces the human placental lactogen hormone (hPL), which increases insulin resistance. In addition, the amount of insulin produced by the mother's body also increases, but if this production is insufficient, GDM can occur.…”

Atualidades no Diabetes gestacional

“…Seu risco é quase 10 vezes maior que nas mulheres que não tiveram DMG. 3,4 Entretanto o risco foi reduzido do DT2 após DMG, em mulheres que fizeram atuações Brazilian Journal of Health Review, Curitiba, v. 5, n. 6, p. 22170-22187, nov./dec., 2022 na dieta e atividade física pré e pós-parto, ambas eficazes nos cuidados de saúde para evitar estas perigosas e dispendiosas complicações causadas pela complicação metabólica.…”