Women's views on postpartum testing for type 2 diabetes after gestational diabetes: Six month follow-up to the DIAMIND randomised controlled trial

Ryswyk, Emer Van; Middleton, PF; Hague, W.; Crowther, Caroline A

doi:10.1016/j.pcd.2015.07.003

Cited by 34 publications

(35 citation statements)

References 32 publications

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“…This requires recognition of the presented associations as an opportunity to modify preventive and long-term care. Such progress hinges on widespread patient and health-care provider education about the unique opportunity to identify and treat modifiable risk factors for adverse health outcomes (209, 210). Strategies to reduce long-term and intergenerational risks associated with pregnancy disorders should include access to interdisciplinary teams to substantially affect future pregnancy outcomes and chronic illness.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

Arabin

Baschat

2017

Front. Pediatr.

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Physiologic adaptations during pregnancy unmask a woman’s predisposition to diseases. Complications are increasingly predicted by first-trimester algorithms, amplify a pre-existing maternal phenotype and accelerate risks for chronic diseases in the offspring up to adulthood (Barker hypothesis). Recent evidence suggests that vice versa, pregnancy diseases also indicate maternal and even grandparent’s risks for chronic diseases (reverse Barker hypothesis). Pub-Med and Embase were reviewed for Mesh terms “fetal programming” and “pregnancy complications combined with maternal disease” until January 2017. Studies linking pregnancy complications to future cardiovascular, metabolic, and thrombotic risks for mother and offspring were reviewed. Women with a history of miscarriage, fetal growth restriction, preeclampsia, preterm delivery, obesity, excessive gestational weight gain, gestational diabetes, subfertility, and thrombophilia more frequently demonstrate with echocardiographic abnormalities, higher fasting insulin, deviating lipids or clotting factors and show defective endothelial function. Thrombophilia hints to thrombotic risks in later life. Pregnancy abnormalities correlate with future cardiovascular and metabolic complications and earlier mortality. Conversely, women with a normal pregnancy have lower rates of subsequent diseases than the general female population creating the term: “Pregnancy as a window for future health.” Although the placenta works as a gatekeeper, many pregnancy complications may lead to sickness and earlier death in later life when the child becomes an adult. The epigenetic mechanisms and the mismatch between pre- and postnatal life have created the term “fetal origin of adult disease.” Up to now, the impact of cardiovascular, metabolic, or thrombotic risk profiles has been investigated separately for mother and child. In this manuscript, we strive to illustrate the consequences for both, fetus and mother within a cohesive perspective and thus try to demonstrate the complex interrelationship of genetics and epigenetics for long-term health of societies and future generations. Maternal–fetal medicine specialists should have a key role in the prevention of non-communicable diseases by implementing a framework for patient consultation and interdisciplinary networks. Health-care providers and policy makers should increasingly invest in a stratified primary prevention and follow-up to reduce the increasing number of manifest cardiovascular and metabolic diseases and to prevent waste of health-care resources.

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Section: Discussionmentioning

confidence: 99%

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

Arabin

Baschat

2017

Front. Pediatr.

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“…Even when specific strategies are used to increase adherence to postpartum screening, rates remain unsatisfactory. In studies with questionnaire applications, some of the reasons why patients did not perform the OGTT are lack of time, difficulties with child care, concern only about the risks of GDM to the fetus during pregnancy and less risk awareness to develop diabetes in the future, transport difficulties, among others [ 38 , 39 ]. Failures in the request of the OGTT by the health care team have been also reported [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Postpartum follow up of gestational diabetes in a Tertiary Care Center

Cabizuca

Rocha

Marques

et al. 2018

Diabetol Metab Syndr

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BackgroundGestational diabetes is a risk factor for future development of type 2 diabetes. The primary aim of this study was to estimate the prevalence of postpartum glucose tolerance status evaluation in pregnancies complicated by gestational diabetes 6–12 weeks after delivery. The secondary one was to identify the factors that are implicated with postpartum glucose retesting.MethodsThis was a retrospective study performed with a cohort of women with gestational diabetes, with prenatal care and delivery at a tertiary care center, from January 2013 to April 2017. The diagnosis of gestational diabetes was based on IADPSG criteria (Fasting ≥ 92 mg/dl, 1 h ≥ 180 mg/dl and/or 2 h ≥ 153 mg/dl, respectively) and the diagnosis of type 2 diabetes and prediabetes were made using the 2016 ADA’s criteria (fasting and 2 h after glucose load ≥ 126 mg/dl and/or ≥ 200 and 100–125 mg/dl and/or 140 and 199 mg/dl, respectively). All women had an appointment scheduled 6–12 weeks postpartum with the results of a 75-g oral glucose tolerance test (OGTT).ResultsOf the 152 evaluated women, 21 (13.8%) returned with the postpartum OGTT results. Of these, 9 (45.0%) had a diagnosis of prediabetes. The use of insulin during gestation was the only factor implicated in a higher adherence rate to postpartum testing OR 6.33 (p 0.002). No significance was found for other demographic and clinical variables (age, family income, years of study, parity, gestational age at first visit, smoking, family history of type 2 diabetes, diagnosis of gestational diabetes before the third trimester, pregestational body mass index, previous history of gestational diabetes and ethnicity).ConclusionThe majority of patients with gestational diabetes did not return postpartum to perform OGTT and in our study the only factor implicated in a higher postpartum return was the use of insulin during pregnancy. Considering that 45.0% were diagnosed with prediabetes, diabetes care teams should initially identify non-adherent patients.

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“…Notably, studies examining communication preferences in postpartum women show that the majority want information and reminders sent electronically or to their phones rather than through voicemail or mail. 38–40 …”

Section: ) Reminder Systemsmentioning

confidence: 99%

Optimizing postpartum care for the patient with gestational diabetes mellitus

Martinez

Niznik

Yee

2017

American Journal of Obstetrics and Gynecology

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Gestational diabetes mellitus (GDM) poses well-established risks to both the mother and infant. As over 50% of women with GDM will develop type 2 diabetes mellitus (T2DM) in their lifetime, performing postpartum oral glucose tolerance testing (OGTT) is paramount to initiation of appropriate lifestyle interventions and pharmacologic therapy. Nonetheless, test completion among women with GDM is estimated to be <50%, with particularly low rates in Latina patients, as well as patients with public insurance, low education levels, and low health literacy. Data suggest our current health services infrastructure loses patients in the postpartum gap between pregnancy-focused care and primary care. As previous studies have demonstrated strategies to promote OGTT completion for T2DM prevention, hereto is a proposal of best practices including 1) enhanced patient support for identifying long-term health care providers 2) patient-centered medical home utilization when possible 3) patient and provider test reminders, and 4) formalized obstetrician-primary care provider hand-offs using the “SBAR” (Situation Background Assessment Recommendation) mnemonic. These strategies deserve future investigation to solidify a multi-level approach for identifying and preventing the continuum of diabetes.

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Women's views on postpartum testing for type 2 diabetes after gestational diabetes: Six month follow-up to the DIAMIND randomised controlled trial

Cited by 34 publications

References 32 publications

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

Pregnancy: An Underutilized Window of Opportunity to Improve Long-term Maternal and Infant Health—An Appeal for Continuous Family Care and Interdisciplinary Communication

Postpartum follow up of gestational diabetes in a Tertiary Care Center

Optimizing postpartum care for the patient with gestational diabetes mellitus

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