Gestational diabetes (GDM) signals risk for young women. In the U.S., GDM affects 3-8% of all pregnancies or 135,000 women each year, and the rate is on the rise. By 6 months post-delivery, 5% develop type 2 diabetes, and the cumulative incidence rises to 60% at 10 years. The condition can both trigger and perpetuate risk for future generations;it is important to find ways to interrupt the cycle. Postpartum glucose screening meets prevention standards of the U.S. Preventive Services Task Force: a simple, proven test with established evidence that early intervention makes a difference. Despite clear recommendations for such testing by key organizations invested in diabetes prevention and women's health, actual use rates are exceedingly low. The reasons for low rates have not been well- studied in diverse settings and remain poorly understood. As a result, few interventions specifically for GDM and based on patient and provider experience have not been developed and evaluated. We propose to address these gaps with two innovative studies in an urban academic center that serves an ethnically and culturally diverse group of low-income women. Study #1 aims to elucidate patients'and providers'perspectives on reasons for low utilization of postpartum glucose screening to inform the adaptation of an established intervention (brief motivational interviewing (BMI)) to GDM. We will conduct in-depth interviews with 30 patients and 24 providers, eliciting their experience with GDM, perceptions of future risks and knowledge and information exchange about postpartum glucose screening and follow-up care. We will analyze the data using content and narrative techniques, and apply findings to the development of an MI-based brief intervention. Study #2 aims to evaluate the feasibility of the intervention, designed to increase the use of postpartum glucose testing. We will enroll 108 women with a GDM diagnosis during the third trimester of pregnancy, randomly assign them to the intervention or usual care, and assess at three months the use of postpartum glucose screening (timing and type) and readiness to test in the future, as well as intensity of effort to enroll and retain. The intervention consists of a 15-20 minute motivational interview during the third trimester of pregnancy and two booster calls to reinforce motivation for the postpartum visit and oral glucose test. 'Extenders'on the existing health care team, culturally and linguistically matched to patients, will carry out the BMI. The approach, if effective, can be both affordable and sustainable as systems of care evolve into medical homes. The proposed study and full-scale R01 to follow will address a critical gap in the inter-conception care of reproductive-aged women, interrupting the cycle of risk for type 2 diabetes signaled by GDM. In so doing, the studies will contribute to slowing the escalating epidemic of diabetes among women, with its enormous individual and social costs.

Public Health Relevance

With rising rates of obesity and diabetes among women (and men) in the U.S. comes an increase in one of the most common complications of pregnancy-gestational diabetes (GDM). For some women, it is a passing condition of pregnancy and for others, it signals risk for type 2 diabetes and its burdensome effects on their health and length o life. Testing for glucose tolerance in the postpartum period is a crucial step for the life- long prevention of diabetes among women with GDM, yet few have received its benefits;we propose to conduct the first known study to understand the reasons for low use of postpartum glucose testing and use our findings to design and test an innovative intervention to promote the use of the test and close this gap in women's health care.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-EMNR-K (80))
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Davis, Maurice
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Boston University
Public Health & Prev Medicine
Schools of Public Health
United States
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Bernstein, Judith A; McCloskey, Lois; Gebel, Christina M et al. (2016) Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes. BMJ Open Diabetes Res Care 4:e000250