Adherence to a follow-up program after gestational diabetes

Aim The aim of this study was to examine attendance for early postpartum follow-up among women with gestational diabetes mellitus (GDM), and to identify factors that influenced their likelihood of attending. Methods One thousand eight hundred and nineteen women with GDM were retrospectively analyzed...

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Bibliographic Details
Published in:	Acta diabetologica Vol. 57; no. 12; pp. 1473 - 1480
Main Authors:	Dalfrà, Maria Grazia, Burlina, Silvia, Del Vescovo, Gloria Giovanna, Anti, Francesca, Lapolla, Annunziata
Format:	Journal Article
Language:	English
Published:	Milan Springer Milan 01-12-2020 Springer Nature B.V
Subjects:	Adult Aftercare - methods Aftercare - statistics & numerical data Birth weight Blood glucose Blood Glucose - metabolism Diabetes Diabetes mellitus Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - prevention & control Diabetes, Gestational - blood Diabetes, Gestational - epidemiology Diabetes, Gestational - therapy Ethnicity Fasting Female Follow-Up Studies Gestational diabetes Glucose Glucose Intolerance - blood Glucose Intolerance - epidemiology Glucose Intolerance - rehabilitation Glucose tolerance Glucose Tolerance Test Hemoglobin Humans Immigrants Insulin Internal Medicine Medicine Medicine & Public Health Metabolic Diseases Minority & ethnic groups Original Article Patient Compliance - statistics & numerical data Postpartum Postpartum Period - blood Prediabetic State - blood Prediabetic State - epidemiology Prediabetic State - therapy Pregnancy Pregnancy and Diabetes Preventive Health Services - statistics & numerical data Retrospective Studies Risk Factors Gestational diabetes mellitus Maternal outcomes Adherence to follow-up Postpartum follow-up Fetal outcomes
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Summary:	Aim The aim of this study was to examine attendance for early postpartum follow-up among women with gestational diabetes mellitus (GDM), and to identify factors that influenced their likelihood of attending. Methods One thousand eight hundred and nineteen women with GDM were retrospectively analyzed. During pregnancy, the following data were collected: age, family history of diabetes, ethnicity, prepregnancy BMI, fasting plasma glucose, glycated hemoglobin, gestational week of GDM diagnosis, timing and mode of delivery, newborn’s birth weight and length. Glycemia and insulinemia during OGTT, lipid profile and postpartum BMI were assessed at follow-up. Based on the OGTT, women were classified as having normal glucose tolerance (NGT) or abnormal glucose tolerance (AGT), which included impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG + IGT, and DM2. Factors predicting postpartum attendance for follow-up and onset of AGT were considered. Results Of the 889 (48.9%) who attended the scheduled postpartum OGTT, 741 (83.4%) had NGT, while 148 (16.6%) had AGT (IFG 6.7%, IGT 7.7%, IFG + IGT 0.8%, DM2 1.5%). The predictors of adherence to follow-up were: not belonging to an immigrant group; family history of DM2; and insulin therapy in pregnancy. The same factors were also predictive of AGT. Our data suggest a role of ethnicity in both attendance for postpartum follow-up and its outcome. Conclusion Despite efforts to provide care for women with GDM, postpartum screening rates are still low among Italian women, and especially among immigrants. Hence, the need to improve these patients’ awareness of the severe risk of developing diabetes after pregnancy, concentrating efforts especially on women belonging to the most at risk ethnic groups.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	0940-5429 1432-5233
DOI:	10.1007/s00592-020-01564-y