Patient Centered Approach to Postpartum Care after Gestational Diabetes: Delphi Method

Abstract

Describe strategies to address the postpartum care transition for women with gestational diabetes, including the use of a patient-centered care plan. Gestational Diabetes Mellitus (GDM) is associated with increased risk for Type 2 Diabetes Mellitus (T2DM) and recurrence of GDM. Women may not receive adequate postpartum care and screening, lending to diabetes risk. While care plans are recommended by leading authorities, there is a lack of consensus on what should be addressed and how care plans can be used to reduce risk for future diabetes. Recommendations for a postpartum care plan were elicited from experts (n = 10) using the Delphi Method. Experts were invited based on their professional experience or research related to GDM. Three rounds of online data collection, including qualitative probes, ranking, and clickable graphic exercises, were used to form a consensus for a care plan. The expert panel recommended that dietitians, particularly those with a diabetes credential take a lead role in discussing a postpartum care plan with patients. Experts encouraged a collaborative and patient-centered process that starts in pregnancy, resulting in actionable steps to reduce risk. Postpartum and lifelong screening, healthy eating, staying active, healthy body weight, along with primary care coordination, breastfeeding support, and psychosocial support were indicated as important to include in the care plan. A patient centered care plan template was developed along with a patient-decision aide as a result of this project. The attributes identified as important for postpartum care fall within the scope of dietitians, particularly those with diabetes specialization. The care plan requires further study and piloting in a patient population.