Postpartum care of women with gestational diabetes: survey of healthcare professionals

Girish Rayanagoudar; Misha Moore; Javier Zamora; Philippa Hanson; Mohammed S B Huda; Graham A Hitman; Shakila Thangaratinam

doi:10.1016/j.ejogrb.2015.09.019

Postpartum care of women with gestational diabetes: survey of healthcare professionals

Eur J Obstet Gynecol Reprod Biol. 2015 Nov:194:236-40. doi: 10.1016/j.ejogrb.2015.09.019. Epub 2015 Sep 28.

Authors

Girish Rayanagoudar¹, Misha Moore², Javier Zamora³, Philippa Hanson², Mohammed S B Huda², Graham A Hitman⁴, Shakila Thangaratinam⁵

Affiliations

¹ Women's Health Research Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK. Electronic address: g.rayanagoudar@qmul.ac.uk.
² Barts Health NHS Trust, London, UK.
³ Women's Health Research Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS) and CIBER Epidemiologia y Salud Publica, Madrid, Spain.
⁴ Women's Health Research Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK.
⁵ Women's Health Research Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK; Multidisciplinary Evidence Synthesis Hub (mEsh), Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

PMID: 26454230
DOI: 10.1016/j.ejogrb.2015.09.019

Abstract

Objective: To assess the knowledge and practices of healthcare professionals on the postpartum care of women with gestational diabetes.

Study design: We surveyed 106 healthcare professionals including obstetricians, diabetologists, general practitioners and midwives in East London and West Midlands in England (September 2014). The questionnaire assessed postpartum screening practices, care provision, future risk and strategies to prevent diabetes in women with gestational diabetes.

Results: The response rate was 87% (92/106). Nearly all respondents offered advice on diet (99%; CI 95%, 100%) and exercise (92%; CI 85%, 97%) postnatally in women with diagnosis of gestational diabetes. The preferred screening time for diabetes was 6 weeks to 3 months postpartum (76%; CI 66%, 85%). Overall, oral glucose tolerance test was the preferred test (57%; CI 46%, 67%), although general practitioners preferred fasting glucose (50%; CI 33%, 67%) and glycated hemoglobin (47%; CI 30%, 64%). Most midwives (81%, 17/21) and obstetricians (52%, 11/21) either underestimated or were unsure of the future risk of diabetes. There was lack of consensus on responsibility for immediate postpartum screening.

Conclusion: The survey highlights the need for improved awareness of future risk of diabetes in women with gestational diabetes, consensus on optimal postpartum screening and identification of the main healthcare provider responsible for further management. This is particularly important for areas of social deprivation.

Keywords: Gestational diabetes; Healthcare professionals; Postpartum screening; Survey; Type 2 diabetes.

MeSH terms

Blood Glucose / metabolism
Diabetes Mellitus, Type 2 / blood
Diabetes Mellitus, Type 2 / diagnosis*
Diabetes, Gestational / therapy*
Diet
Directive Counseling
Exercise
Fasting
Female
General Practice
Glucose Tolerance Test
Glycated Hemoglobin / metabolism
Health Knowledge, Attitudes, Practice*
Humans
London
Midwifery
Obstetrics
Physician's Role*
Postnatal Care*
Practice Patterns, Physicians'*
Pregnancy
Surveys and Questionnaires

Substances

Blood Glucose
Glycated Hemoglobin A
hemoglobin A1c protein, human