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Gestational Diabetes Mellitus Postpartum Follow-Up Testing: Challenges and Solutions

      Abstract

      One in every 4 pregnancies is affected by hyperglycemia, of which 90% is gestational diabetes mellitus (GDM). Women with GDM are at a high risk of developing both short- and long-term complications. Various studies have shown the heightened risk of type 2 diabetes among women with GDM. Despite clear evidence from published literature about the substantial risk that GDM imposes on women after delivery, rates of postpartum follow up have been low in most parts of the world. Several reasons, such as lack of awareness among health-care professionals and patient-related barriers, such as emotional stress and adjusting to motherhood, have been cited as reasons for poor follow-up rates. To address these issues and come up with solutions to improve postpartum follow-up rates, it is important to understand these barriers both from the patient and the health-care system points of view. In this review, we have summarized some of the key issues contributing to the low postpartum follow-up rates and have discussed possible strategies to tackle them. Use of proactive reminder systems, such as postal service, telephone call, short messaging service and e-mail, recall registries for GDM and utilization of mobile health technology are some of the key strategies that have been discussed in this review. A brief note on the Women in India with GDM Strategy project, which developed a model of care for GDM in resource-constrained settings and adopted several strategies that led to a 95.8% postpartum follow up, has also been presented.

      Résumé

      Une femme enceinte sur 4 est atteinte d'hyperglycémie. Parmi ces femmes, 90 % sont atteintes du diabète sucré gestationnel (DSG). Les femmes atteintes du DSG sont exposées à un risque élevé de subir des complications à court et à long termes. Plusieurs études ont montré que les femmes atteintes du DSG sont exposées à un risque accru de diabète de type 2. Bien que la littérature publiée ait clairement montré que le DSG fait courir un risque important aux femmes après l'accouchement, les taux de suivi post-partum étaient faibles dans la plupart des régions du monde. Plusieurs raisons ont été avancées pour expliquer les faibles taux de suivi. Parmi ces raisons, notons le manque de connaissances des professionnels des soins de santé et les obstacles liés à la patiente, comme le stress émotionnel et l'adaptation à la maternité. Pour aborder ces questions et trouver des solutions pour améliorer les taux de suivi post-partum, il est important de comprendre les obstacles liés à la patiente et le point de vue du système de soins de santé. Dans la présente revue, nous avons résumé certaines de ces grandes questions qui contribuent aux faibles taux de suivi post-partum et avons discuté des stratégies possibles pour y remédier. Le recours aux systèmes proactifs de rappel, comme les services postaux, les appels téléphoniques, les messages textes et les courriels, les registres de rappels du DSG et l'utilisation des technologies mobiles en santé constituent les grandes stratégies dont nous parlons dans cette revue. Nous avons également présenté une note succincte sur le projet Women in India with GDM Strategy, qui a permis l’élaboration d'un modèle de soins aux patientes atteintes de DSG dans des contextes de ressources limitées et l'adoption de nombreuses stratégies ayant mené à un suivi post-partum de 95,8 %.

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