Benefits of Screening Women for Diabetes After Delivery Capstone Project

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SYNTHESIS

Gestational diabetes mellitus (GDM), glucose intolerance recognized during pregnancy, affects approximately 7% of all pregnancies in the United States. GDM, diagnosed by an abnormal oral glucose tolerance test (OGTT) done during the second trimester. Women diagnosed with GDM are at a high risk of developing type 2 diabetes, cardiovascular disease, and hypertension. With this prevalence, the American Diabetes Association (ADA) has recommended screening women with GDM 6-12 weeks after delivery, which roughly coincides with the timing of their first postpartum visit. For almost 90% of women diagnosed with GDM, glucose intolerance will resolve immediately after delivery, but their risk of developing type 2 diabetes mellitus is 35% to 60%. There is also a likelihood of the woman adversely affecting their future offspring when they become pregnant again with undiagnosed type 2 diabetes mellitus or they experience recurrent GDM. There is a need to analyze the factors contributing to and hinder women's screening during their postpartum visit. The literature review will be structured using identified variables to focus on the barriers, attitude, knowledge and awareness, and postpartum screening visits. These themes will establish the importance of screening for GDM during the postpartum visit and its impact on compliance with healthcare.

Synthesis of Literature

Postpartum Screening Visits

A majority of new mothers will not miss out on their first postpartum visit, which would be the opportune time for them to undergo GDM screening. As posited by Bandyopadhyay, Small, and Davey (2015), many women are aware of the risks and perceived inevitability of developing type 2 diabetes. Hence, they would be willing to present themselves for GDM screening during their 6-week postpartum visit. However, as Cho et al. (2015) noted, 51% of women who had been diagnosed with GDM failed to return to complete their postpartum glucose testing. Therefore, there is a need to determine the reasons for these high noncompliance numbers and determine ways of increasing compliance (Korpi-Hyövälti et al., 2012). Carson et al. (2015) established one of the reasons for noncompliance was directing the women to undergo testing at an outside laboratory instead of the same hospital where they are undergoing their postpartum visit. Having the women going to an outside laboratory becomes hectic, and most women will not present to the laboratory due to the time-consuming nature of the process. Considering the recommended screening time for GDM by the ADA is an arbitrary endpoint. Women diagnosed with GDM can be screened immediately after delivery and before their discharge as a way of increasing compliance with postpartum testing (Carter et al., 2018).

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Early testing increases the rates of tested women since the patients are relaxed and still in the hospital. With the initial postpartum OGTT results, patients can be informed of their abnormal results early, which would encourage them to come for their follow-up test during their first postpartum visit (Sunny et al., 2020).

Knowledge and Awareness

The underlying reason for the low numbers of women who return for GDM screening is the lack of knowledge and awareness. When the women are first diagnosed with GDM during their pregnancy, the physician will inform them of the need for a follow-up test after delivery (Carter…

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…al., 2015). Having a young baby and leaving the baby or going to the clinic with the baby and staying there for those extended periods was not favorable for most women (Sunny et al., 2020). The women have to choose between their health and caring for their young baby. In most cases, the women will opt to postpone the test, which results in them never taking the test as they continue to lack the time. Physicians have been a barrier too, numerous women have visited clinics multiple times, having been diagnosed with GDM, and they still did not get the test (Rosenbloom & Blanchard, 2018). Bandyopadhyay et al. (2015) found the physician's lack of information or the failure to hand over patient records to be the underlying cause of this issue. Korpi-Hyövälti et al. (2012) added communication needs to be improved between primary care physicians and obstetrics and gynecology care providers, ensuring patient information is appropriately shared and follow-up done.

New mothers feel overwhelmed by the baby, especially if they do not receive any support from family members. In most cases, the women did not have someone to leave the baby with, and the healthcare facility did not have baby care services (Cho et al., 2015). Mothers had to stay with the baby for the test's duration, which prevented many mothers from doing the test (Shah et al., 2011). The lack of assistance for the mothers in caring for the baby when they go for the test is a hindrance that echoed by Bandyopadhyay et al. (2015). Without any assistance or someone to leave the baby with,….....

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