The “missing window of opportunity” for preventing diabetes: A mixed method study on postpartum screening for diabetes among women with gestational diabetes mellitus in Kerala, India

Abstract

Background: The prevalence of gestational diabetes mellitus (GDM) is ranging from 15.9% to 17% in Kerala. Women with GDM and their offsprings are at increased risk of developing type 2 diabetes mellitus in their later life. Hence, postpartum screening and follow-up of the women with GDM along with nutritional and lifestyle modification support are extremely important in Kerala. This study revealed the clients' and providers' perspective on the postpartum diabetes screening among GDM mothers. Objectives: The study aimed to assess timely postpartum diabetes screening rate and factors associated with postpartum diabetes screening among women with GDM who had recently delivered at selected hospitals in Malappuram district, Kerala. The study also assessed the clinicians' perspective on postpartum diabetes screening of women with GDM. Materials and Methods: A cross-sectional study was done among 200 women with GDM, who had delivered in selected hospitals in Malappuram districts between 9 weeks and 6 months before the survey using a pretested validated interview schedule. In-depth interview was carried out to explore the clinicians' perspective on postpartum diabetes screening of women with GDM. Results: Timely postpartum diabetes screening rate among respondents was 29%. The age-adjusted multivariate logistic regression analysis result had a significant P value for the health-care provider's advice with an adjusted OR of 3.2 (1.4–6.9). About 6% of the women with GDM received appropriate and adequate postpartum follow-up. Conclusion: There is an urgent need to enforce adherence to national guidelines for postpartum diabetes screening and establishment of registration and follow-up of women with GDM through public health-care delivery system.