Barriers to Postpartum Glucose Intolerance Screening in an Italian Population

Int J Environ Res Public Health. 2018 Dec 14;15(12):2853. doi: 10.3390/ijerph15122853.

Abstract

Background: Gestational diabetes mellitus (GDM) is a strong risk factor for type 2 diabetes mellitus (T2D) and the postpartum period is crucial for early treatment in at-risk women. However, despite recommendations, only a fraction of women undergo a postpartum screening for glucose intolerance (ppOGTT). The present study aims to verify the reason(s) for poor adherence in our population. Research design and methods: This retrospective study includes 451 women in which GDM was diagnosed between 2015⁻2016. During 2017, we verified by phone interview how many women underwent ppOGTT at 6⁻12 weeks postpartum, as recommended by the Italian guidelines. The non-compliant women were asked about the reason(s) for failing to screen. The non-parametric Mann-Whitney test and the 2-tailed Fisher exact test were used to compare continuous and categorical features, respectively, among women performing or non-performing ppOGTT. Results: Out of 451 women with GDM diagnosis, we recorded information from 327. Only 97 (29.7%) performed ppOGTT. The remaining 230 women (70.3%) provided the following explanation for non-compliance: (1) newborn care (30.4%); (2) misunderstood importance (28.3%); (3) oversight (13.0%); (4) unavailability of test reservation in the nearest centers (10.4%); (5) normal glycemic values at delivery (8.3%); (6) discouragement by primary care physician (5.6%). Conclusions: In our population, most women with recent GDM failed to perform ppOGTT. Our results indicated that the prominent barriers could potentially be overcome.

Keywords: gestational diabetes mellitus; ppOGTT; type 2 diabetes mellitus.

MeSH terms

  • Adult
  • Diabetes, Gestational / epidemiology*
  • Female
  • Glucose Tolerance Test / statistics & numerical data*
  • Humans
  • Italy / epidemiology
  • Longitudinal Studies
  • Mass Screening / psychology
  • Mass Screening / statistics & numerical data*
  • Postnatal Care / psychology
  • Postnatal Care / statistics & numerical data*
  • Pregnancy
  • Retrospective Studies
  • Risk Factors