Gestational diabetes mellitus follow-up in Norwegian primary health care: a qualitative study

BackgroundWomen with gestational diabetes mellitus (GDM) have a tenfold increased risk of developing diabetes, and a high risk of recurrent GDM. Endorsing the life-course approach aiming to prevent disease and promote health across generations, the Norwegian GDM guideline recommends follow-up in primary care after delivery, with information on the increased risks, lifestyle counselling, and annual diabetes screening. Few reports exist on Norwegian women’s experiences of GDM follow-up. AimTo elucidate women’s experiences with follow-up of GDM in pregnancy and after delivery, and to explore their attitudes to diabetes risk and motivation for lifestyle changes. Design & settingQualitative study in primary care in the region of Stavanger, Norway. MethodSemi-structured in-depth interviews were conducted 24–30 months after delivery with 14 women aged 28–44 years, with a history of GDM. Data were analysed thematically. ResultsMost women were satisfied with the follow-up during pregnancy; however, only two women were followed-up according to the guideline after delivery. In most encounters with GPs after delivery, GDM was not mentioned. To continue the healthy lifestyle adopted in pregnancy, awareness of future risk was a motivational factor, and the women asked for tailored information on individual risk and improved support. The main themes emerging from the analysis were as follows: stigma and shame; uncertainty; gaining control and finding balance; and a need for support to sustain change. ConclusionWomen experienced a lack of support for GDM in Norwegian primary care after delivery. To maintain a healthy lifestyle, women suggested being given tailored information and improved support.

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Women's engagement, views and experiences of postnatal follow-up after Gestational Diabetes Mellitus in pregnancy

Midwifery ◽

10.1016/j.midw.2021.103043 ◽

2021 ◽

pp. 103043

Author(s):

Siân Pierce Roberts ◽

Sheila JS Brown ◽

Dr Seren Haf Roberts

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

In Pregnancy

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Barriers to and Facilitators of Postpartum Follow-Up Care in Women with Recent Gestational Diabetes Mellitus: A Qualitative Study

Journal of Women s Health ◽

10.1089/jwh.2010.2233 ◽

2011 ◽

Vol 20 (2) ◽

pp. 239-245 ◽

Cited By ~ 85

Author(s):

Wendy L. Bennett ◽

Christopher S. Ennen ◽

Joseph A. Carrese ◽

Felicia Hill-Briggs ◽

David M. Levine ◽

...

Keyword(s):

Diabetes Mellitus ◽

Qualitative Study ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Follow Up Care

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Evaluation of sleep quality and duration in pregnancy and risk of gestational diabetes mellitus: A prospective follow-up study

BioMedicine ◽

10.37796/2211-8039.1139 ◽

2021 ◽

Vol 11 (2) ◽

pp. 24-29

Author(s):

Saloumeh Peivandi ◽

Ali Habibi ◽

Seyed Hamzeh Hosseini ◽

Mohammad Khademloo ◽

Mohammad Raisian ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Sleep Quality ◽

Gestational Diabetes Mellitus ◽

Follow Up Study ◽

In Pregnancy

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Continuing Challenges in The Medical Management of Gestational Diabetes Mellitus

EMJ Diabetes ◽

10.33590/emjdiabet/20-00003 ◽

2020 ◽

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

High Risk ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Diabetes In Pregnancy ◽

In Pregnancy

The management of gestational diabetes mellitus (GDM) involves screening (or universal testing), a diagnostic oral glucose tolerance test, patient counselling/education, gestational weight management and medical nutrition therapy, and self-monitoring of blood glucose levels with regular glycaemia reviews. This is in addition to pharmacological treatment, often insulin therapy, if glycaemia is above target. Females with GDM receive more frequent ultrasound testing to assess fetal growth, and birth is planned and not usually allowed to go much past term. A range of challenges continue to arise in GDM management including screening approaches and diagnostic criteria, dealing with the increasing numbers of females diagnosed, weight and glycaemic targets, the long-term safety of oral antihyperglycaemic agents for the offspring, particularly metformin, and adjunct medication for complication prevention. GDM management involves additional complexities including differentiating between those with likely undiagnosed Type 2 diabetes mellitus (diabetes in pregnancy), how to manage females with high glucose early in pregnancy less than diabetes in pregnancy, and identifying females with rare causes, for example monogenic diabetes or new Type 1 diabetes mellitus in pregnancy. While the management of GDM has evolved from identifying females at high risk of progressing to Type 2 diabetes mellitus, to greater focus on improving pregnancy outcomes, females with prior GDM and their offspring have the highest need for follow-up and prevention strategies. To date, follow-up and intervention remains limited for this high-risk group for both diabetes and cardiovascular disease. Follow-up in these females is particularly important for the next pregnancy, especially as GDM prevention from the second trimester onwards remains another continuing challenge.

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