Gestational diabetes mellitus (GDM) poses a substantial long-term health burden to women due to the 7-fold increased risk of developing type 2 diabetes mellitus (T2DM) and other cardiovascular disorders. Yet, there are many gaps in the transition period after GDM, which is a particularly critical time due to enhanced motivation and access. Nevertheless, a minority of women receive postpartum screening for dysglycemia or have successful transition to primary care. Although T2DM prevention interventions can be successful, they cannot be deployed without retention and engagement in care. Addressing the unique barriers experienced by postpartum women requires innovative models of health care delivery to promote prevention of T2DM after GDM. One potential intervention with demonstrated successes in other arenas is patient navigation, a barrier-focused, longitudinal, patient-centered intervention that offers support for a defined set of health services. This R34 proposal is a 2-year research plan for a pilot assessment of Sustaining Women's Engagement and Enabling Transitions after GDM (SWEET), a GDM-focused intervention that will apply barrier-reduction patient navigation strategies to improve health after a pregnancy with GDM.
We aim to determine, via a randomized controlled trial of 40 women who have had GDM, whether those who receive the SWEET navigation intervention have improved diabetes-related health at 1 year after birth compared to those who receive usual care. In order to promote self-efficacy, enhance access, and sustain long-term engagement, the SWEET intervention will provide GDM-specific, individualized navigation services that leverage existing clinical infrastructure, including logistical support, psychosocial support, and health education, through 1-year postpartum.
Aim 1 will evaluate whether clinical (weight, glycemic control, abdominal circumference, and blood pressure), health services (postpartum and primary care visit attendance), and patient-reported (diabetes self-efficacy, activation, and T2DM risk perception) outcomes differ in women exposed to SWEET versus usual care.
Aim 2 will evaluate feasibility and acceptability. SWEET is designed to be a pragmatic and clinically-integrated intervention. This proposal will generate key data for the conduct of a full-scale trial of a GDM-specific postpartum patient navigation program that will address critical questions about long-term maternal health and T2DM prevention. SWEET bridges the chasm between care during pregnancy ? focused on improving the health of the pregnant woman and her offspring ? and long-term women?s health care ? focused on chronic disease management and preventive health. We are dedicated to identifying how we can improve early identification of T2DM, lifestyle modification, retention in care, and transitions to primary care after GDM. Achieving these goals will enhance women?s long-term and subsequent pregnancy health, both of which are consistent with the NIDDK mission to prevent or ameliorate the effects of T2DM beyond the perinatal period.

Public Health Relevance

Gestational diabetes mellitus (GDM) poses significant long-term health burdens to women due to the elevated risk of future type 2 diabetes (T2DM). Yet, there are many gaps in the transition period after GDM, as postpartum women experience unique barriers that commonly preclude their ability to engage in T2DM prevention, and thus innovative models of healthcare delivery are needed to support this critical transitional period. This proposal to evaluate a GDM-focused patient navigation program among postpartum women who had GDM has the potential to meaningfully improve the long-term health of women who had GDM by enhancing access, engagement, and adoption of lifestyle interventions critical to T2DM prevention.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Planning Grant (R34)
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Special Emphasis Panel (ZDK1)
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Linder, Barbara
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Northwestern University at Chicago
Obstetrics & Gynecology
Schools of Medicine
United States
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