Women who develop diabetes during pregnancy – called gestational diabetes or GDM – have a relatively high risk of developing type 2 diabetes after their babies are born. Blood tests to screen for diabetes after the birth of the baby, and annually thereafter, are recommended to avoid delays in diagnosis and treatment. However, many women do not arrange tests or do not attend their appointments to have the test done.
To find out what might help, Becky Dennison and fellow researchers at the Prevention Group in the Primary Care Unit looked at the views of women concerning screening for diabetes. They identified and reviewed all the published literature on this topic to work out both what gets in the way for the mothers and what makes access easier. On the basis of the evidence they reviewed, they suggest a set of key messages for all mothers who have had gestational diabetes as well as some potential changes to how the screening is organised.
The research team identified four distinct factors that affected women as they decided whether or not to go for a glucose test. Their relationships with healthcare staff made a big difference, and continuity of care in particular was cited as an enabling factor: ‘It meant a lot to me that I didn’t have to see a new person every time I was there.’
The logistics of both the appointment and the glucose test itself affected women’s response to their appointments and they explained that, for example, travel time would stop them going if the journey seemed too long. Many mentioned the challenges of life with a new baby and some made it clear that the possibility of a type 2 diabetes diagnosis that would affect them long term was frightening and made them avoid attendance. ‘It’s, like, oh my gosh, I don’t want to have it [type 2 diabetes]. And so, I guess, in my mind, it’s been, if I don’t get checked, maybe I won’t develop it’.
It’s easy to see how women with small children might find it difficult to make and keep appointments and we also found lots of evidence about fragmented care and mixed messages about the screening. There’s a substantial health gain to be made if the testing regime could be strengthened and made more sensitive to women’s needs alongside effective messages to boost the mothers’ motivation to attend.”
– Becky Dennison, researcher at the Prevention Group
Overall, the team discovered a significant gap in women’s understanding about why screening is important and how the test is carried out.
On the basis of the barriers to screening that they uncovered, they propose a new set of key messages explaining why screening is important.
If communicated effectively, such messages could help to tackle the knowledge gap and therefore promote women’s capability and motivation to have their tests done, the team suggest. They also suggest tweaks to the screening programme to increase uptake. Personalised reminders – for example, text messages from their GP in the month of the child’s birthday – were cited as effective by some clinicians.
Women with GDM have seven times higher risk of developing diabetes in the years following their pregnancy than women without GDM. Unfortunately, many have untreated diabetes for an unnecessarily long time. Our research matters because if we can improve the uptake of screening in this particularly high risk group, we can reduce the amount of time that their diabetes is untreated and reduce their long-term risk of developing complications of diabetes, chiefly cardiovascular disease.
Furthermore, we can reduce the chance that the early stages of a subsequent pregnancy are affected by high blood glucose levels from untreated diabetes, which increases risk of foetal abnormalities and complications of pregnancy.”
– Professor Simon Griffin, co-author and Professor of General Practice, Primary Care Unit
This research is part of Becky Dennison’s work into the experience of women who have had gestational diabetes and the impact of interventions meant to improve their health by reducing the risks of developing type 2 diabetes after their babies are born.
Funded by the National Institute for Health Research (NIHR) School for Primary Care Research.
Read the study
R Dennison, R Fox, R Ward, S Griffin, J Usher‐Smith. Women’s views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake. Diabetic Medicine. 18 July 2019
About the Prevention Group at the Primary Care Unit
More about Becky’s work on gestational diabetes
Media queries: Lucy Lloyd, Primary Care Unit Communications Manager
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