From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review.
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.
Department of International Health, Immunology and Microbiology, University of Copenhagen, Oester Farimagsgade 5, Building 9, Copenhagen DK-1014, K, Denmark. kani@sund.ku.dk.
Karoline Kragelund
KK
Nielsen
Anil
A
Kapur
Peter
P
Damm
Maximilian
M
de Courten
Ib Christian
IC
Bygbjerg
D015992:Body Mass Index; D001835:Body Weight; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D010349:Patient Compliance; D011181:Postnatal Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011295:Prenatal Care