Women's views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake

Abstract

Aim Many women do not attend recommended glucose testing following a pregnancy affected by gestational diabetes (GDM). We aimed to synthesize the literature regarding the views and experiences of women with a history of GDM on postpartum glucose testing, focusing on barriers and facilitators to attendance. Methods We systematically identified qualitative studies that examine women's experiences following GDM relating to glucose testing (diabetes screening) or experience of interventions to promote uptake of testing. We conducted a thematic synthesis to develop descriptive and then analytical themes, then developed recommendations to increase uptake based on the findings. We evaluated the quality of each study and the confidence that we had in the recommendations using published checklists. Results We included 16 articles after screening 23 160 citations and 129 full texts. We identified four themes of influences relating to the healthcare system and personal factors that affected both ability and motivation to attend: relationship with health care, logistics of appointments and tests, family‐related practicalities and concern about diabetes. We developed 10 recommendations addressing diabetes risk information and education, and changes to healthcare systems to promote increased attendance at screening in this population, most with high or moderate confidence. Conclusions We have identified a need to improve women's understanding about Type 2 diabetes and GDM, and to adjust healthcare provision during and after pregnancy to decrease barriers and increase motivation for testing. Encouraging higher uptake by incorporating these recommendations into practice will enable earlier management of diabetes and improve long‐term outcomes.

Facilitators and Barriers to Post-partum Diabetes Screening Among Mothers With a History of Gestational Diabetes Mellitus–A Qualitative Study From Singapore

“…In addition, healthcare institutions can consider offering on-site childcare services or provide play areas for older children, as suggested by many mothers. This proposal aligns with the recommendations suggested by Dennison et al in their systematic review ( 14 ), and will apply not just for postpartum visits but will facilitate mothers seeking medical attention.…”

“…Mothers should be made aware of such options early during their antenatal visits via clear, uniform instructions by both their obstetricians and primary care physicians. As these test can be planned weeks in advance, the option of scheduling a mother's post-partum diabetes screening with other appointments at suitable locations should be offered routinely by the institution ( 14 ).…”

“…A systematic review in 2019, based on 16 qualitative research studies, detailed four major themes. These were broadly classified according to the health-care system and personal factors such as the mother's relationship with her physician; experience of the OGTT; mother's perceived risk of T2DM and family-related complexities ( 14 ). Singaporean mothers with GDM probably encounter similar facilitators and barriers.…”

The absolute and relative risk of type 2 diabetes after gestational diabetes: A systematic review and meta-analysis of 129 studies

“…However, uptake of postpartum screening is suboptimal, even for the first test [12,13]. Women may not attend testing due to its inconvenience or unpleasantness, but also may not have had attendance promoted appropriately by their clinicians during and after pregnancy [14]. Similarly, they may not appreciate or prioritise the need to make changes to their lifestyle to reduce diabetes risk and feel unsupported to achieve sustained behaviour change [15].…”

Baby New Year

“…Dennison et al . explore women's views on screening for type 2 diabetes after a pregnancy complicated by gestational diabetes. The risk of diabetes increases eightfold after gestational diabetes, with up to a half of women developing diabetes within 10 years.…”