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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

From screening to postpartum follow-up – the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review

Authors: Karoline Kragelund Nielsen, Anil Kapur, Peter Damm, Maximilian de Courten, Ib Christian Bygbjerg

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

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Abstract

Background

Gestational 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.

Methods

To 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.

Results

Adherence 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.

Conclusions

The paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context.
Appendix
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Metadata
Title
From screening to postpartum follow-up – the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review
Authors
Karoline Kragelund Nielsen
Anil Kapur
Peter Damm
Maximilian de Courten
Ib Christian Bygbjerg
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-41

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