Understanding type 2 diabetes screening uptake after gestational diabetes

Insights from ACBRD research reveal barriers to type 2 diabetes screening among women with prior gestational diabetes

By Sarah Manallack

Gestational diabetes mellitus (GDM) affects about 13% of pregnancies worldwide. It is characterised by elevated blood glucose levels during pregnancy. While glucose levels usually return to target range after childbirth, women with a history of GDM have greater risk of developing pre-diabetes or type 2 diabetes in the future.

Regular screening is recommended for women with prior GDM, as early detection of type 2 diabetes supports better health in the future. Australian guidelines recommend screening 6-12 weeks after childbirth and every 1-3 years thereafter. But around half of women with prior GDM do not undergo this screening. The ME-MaGDA study, led by Prof Jane Speight, aimed to understand why this might be and find ways to overcome barriers to screening.

To get started, we first reviewed the existing scientific literature. A summary of our review is available here. Next, we interviewed nineteen women with prior GDM. We asked questions, and coded the data, using the “Theoretical Domains Framework”. This framework helped us to identify important barriers and consider ways we might overcome these in the future. Read the full paper here.

Here’s what we found:

1. 1. 1. Knowledge & Awareness. Most women understood the purpose of postpartum screening and the link between GDM and type 2 diabetes. But many were unaware of the ongoing screening recommendations and their continued risk of type 2 diabetes. 
      2. Mental Load & Memory. Managing the mental load of life with a newborn is challenging. The women found it hard to remember the screening recommendations, but felt that screening reminders were helpful.
      3. Screening Process, Environment & Education. Adjusting to new routines and demands of a newborn made it hard to find time for screening. Screening after childbirth was seen as impractical, as was the lack of child-friendly facilities. The women also had safety concerns because of the COVID-19 pandemic and didn’t want to leave their newborn with someone else while attending screening. Some felt they didn’t get much information about screening after childbirth (compared with while pregnant). While others felt they got too much information in general, making it hard to find the screening information.
      4. Communication & Social Support. Health professionals were a trusted information source, especially when the same ones were seen regularly. Most of the women were told about the risk of type 2 diabetes by their health professionals, but not many were told about the need for regular screening. Support from family and friends and awareness of others’ screening experiences influenced screening uptake.
      5. Fear, Anxiety & Feeling Alone After Childbirth. Fear of a type 2 diabetes diagnosis put off some women from screening, while for others, it was a motivation. For some women, the peace of mind from knowing their blood glucose levels motivated regular screening. But others worried that screening might cause problems or didn’t like needles. The women needed ongoing support to prioritise their health after having their baby but felt they didn’t get as much support after childbirth (compared with while pregnant).
      6. Perceived Need, Anticipated Outcomes & Consequences. Some of the women felt that screening was crucial for their future health, while others felt it was unnecessary if they didn’t have any signs of elevated blood glucose, or if their earlier screens were in the target range. Some were motivated to screen because they wanted to know how they were doing health-wise. The thought that they might have undiagnosed type 2 diabetes was a barrier to screening for some women, but a motivator for others. Some of the women saw the screening as a chance to have some time to themselves after childbirth. And few women described any negative consequences of screening.
      7. Social Identity. Motherhood changed how the women viewed their health. Some put their children’s health first, while others saw self-care as part of being a “good mum”.
      8. Perceived Competence & Belief in Managing Risk. Some of the women felt they could forgo continued screening through self-checking their blood glucose levels or healthy behaviours. A few women also felt they would know if they had type 2 diabetes based on how they felt (that they would recognise its symptoms). Whether the women thought that type 2 diabetes could be prevented, delayed, or managed also affected if they got screened or not.

These findings highlight the importance of ongoing support for women with prior GDM to encourage regular type 2 diabetes screening. If you want to know more, check out this NDSS factsheet about life after GDM and our other blogs on gestational diabetes and type 2 diabetes.

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Reference:

Lake AJ, Williams A, Neven ACH, Boyle JA, Dunbar JA, Hendrieckx C, Morrison M, O’Reilly SL, Teede H, & Speight J on behalf of the ME-MaGDA study group. Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A qualitative study applying the Theoretical Domains Framework. Frontiers in Clinical Diabetes and Healthcare, 2023;4:1086186.