Effect of prenatal counseling on postpartum follow-up and contraceptive use in women with gestational diabetes mellitus: a randomized controlled trial

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Postpartum visit attendance for glucose screening and uptake of effective contraception is crucial after a pregnancy with gestational diabetes mellitus (GDM). Although postpartum women with recent GDM are generally advised in the early postnatal period to attend postpartum visits, data have shown suboptimal rates of postpartum glucose testing and highly effective contraceptive use in these women. Compared to the early postnatal period, the antenatal period is when women and healthcare providers have more contact. This may facilitate a better relationship between the pregnant woman and her healthcare providers, thereby improving the women's trust in the providers' counseling. This study aimed to investigate whether adding prenatal counseling to routine early postnatal counseling increases the rates of glucose screening and contraceptive use by 6 weeks postpartum in pregnant women with GDM. A randomized controlled trial including 280 women diagnosed with GDM was conducted. Participants were randomly allocated (1:1, stratified with a permuted block method) to the intervention group (receiving prenatal counseling at 35-36 weeks of gestation plus routine early postnatal counseling) or the control group (receiving only routine early postnatal counseling). The two primary outcomes were glucose screening and highly effective contraceptive uptake by 6 weeks postpartum. The secondary outcome was the use of any contraceptive by 6 weeks postpartum. Data were analyzed according to the intention-to-treat principle. The rate of postpartum glucose screening was 86.4% (121/140) in the intervention group, which was significantly higher than the 50.7% rate (71/140) in the control group (adjusted relative risk [RR], 1.70; 95% confidence interval [CI], 1.27-2.28). The uptake of highly effective contraceptive methods was increased in the intervention group compared to that in the control group (59.3% vs 30.7%; adjusted RR, 1.90; 95% CI, 1.31-2.74). The uptake of any contraceptive method by 6 weeks postpartum was reported by 122 of 140 participants (87.1%) in the intervention group and 77 of 140 participants (55.0%) in the control group (adjusted RR, 1.58; 95% CI, 1.19-2.10). Adding prenatal counseling to routine early postnatal counseling significantly increased the rates of glucose screening and contraceptive use by 6 weeks postpartum in pregnant women with GDM. Given that incorporating counseling regarding postpartum glucose testing and effective contraceptive use into standard prenatal care requires minimal increases in expenditure and manpower, implementation of this counseling strategy in clinical practice seems advisable.