Abstract
BackgroundGestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised.MethodsTo investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed.ResultsAdherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants.ConclusionsThe paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context.
Highlights
Gestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies
The remaining 98 articles were read for relevance for this review and a further 55 were excluded because of lack of relevance i.e. studies did not look at determinants or barriers to GDM services
Barriers for GDM screening Nielsen et al interviewed the implementing partners of 11 GDM projects funded by the World Diabetes Foundation in various developing countries and found various challenges in GDM screening and diagnosis including difficulties in screening women during the recommended time period, applicability and relevance of the risk factors used in selective screening programmes, challenges in testing women in the fasting state and need for repeated testing, screening procedure being too time consuming, scarcity of test consumables and lack of equipment etc. [15]
Summary
Gestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. Clinical trials provide evidence that lifestyle modifications as well as pharmacological interventions can prevent progression to type 2 diabetes in women with a history of GDM and these interventions are as effective as in people with pre-diabetes [12,13,14]. Effective intervention requires universal antenatal screening for GDM, optimal treatment and adherence, and rigorous postpartum follow-up and preventive care. In this paper we attempt to identify determinants and barriers to implementing effective and integrated public health initiatives to address screening, diagnosis, treatment and postpartum care for GDM based on a review of published studies on the subject
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