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      How Can We Increase Postpartum Glucose Screening in Women at High Risk for Gestational Diabetes Mellitus?

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          Abstract

          Women with a history of gestational diabetes mellitus (GDM) are at increased risk for diabetes mellitus but postpartum followup is problematic for frequent nonattendance. Our aim was to increase coverage of postpartum oral glucose tolerance tests (ppOGTTs) and examine associated factors. This was a prospective observational study of altogether 266 high-risk women for GDM from 2005 to 2008 in four Finnish municipalities. The groups were as follows: women ( n = 54) who had previously participated in early pregnancy lifestyle intervention study and high-risk women ( n = 102) from the same municipalities studied within one-year after delivery. Furthermore, in two neighboring municipalities nurses were reminded to perform a ppOGTT on high-risk women ( n = 110). The primary outcome was the prevalence of ppOGTT performed and associated factors. Overall the ppOGTT was performed in 35.7% of women. Only 14.7% of women returned for testing to health care centers, 30.9% after a reminder in municipalities, and 82.5% to the central hospital, respectively. The most important explaining factor was a special call or reminder from the central hospital (OR 13.4 (4.6–38.1), P < 0.001). Thus, additional reminders improved communication between primary care and secondary care and more attention to postpartum oral glucose testing in primary care are of great importance.

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          Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus.

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            Gestational weight gain and long-term postpartum weight retention: a meta-analysis.

            Gestational weight gain (GWG) is known to be a potential risk factor for short-term postpartum weight retention (PPWR) and thus for overweight in women. Does GWG also determine the long-term risk of overweight in women? We aimed to study the short- and long-term effects of GWG in accordance with the Institute of Medicine (IOM) recommendations on postpartum weight retention. We systematically reviewed 5 databases and bibliographies of various publications supplemented by hand search for relevant articles published in English or German and performed meta-analyses to quantify the effect estimate of PPWR by using a random-effects model. We split the data into 4 categories of follow-up: <0.5, 0.5-1, ∼3, and ≥15 y. Of 1770 search hits, 9 observational studies remained suitable for the analysis. PPWR increased after longer time spans after delivery irrespective of whether GWG had been below, within, or above the guidelines. Compared with women with GWG within the recommendations, those with a GWG above the recommendations retained an additional 3.06 kg (95% CI: 1.50, 4.63 kg) after 3 y and 4.72 kg (95% CI: 2.94, 6.50 kg) on average after ≥15 y postpartum. Inadequate GWG was associated with less PPWR (-2.99 kg; 95% CI: -3.72, -2.27 kg) <6 mo after pregnancy. This association faded over time and became nonsignificant (-1.41 kg; 95% CI: -3.03, 0.21 kg) after ≥15 y. The results remained stable in sensitivity analyses that accounted for changes in IOM criteria over time and potential effect modification by low social class. A funnel plot did not suggest publication bias. GWG in accordance with the IOM recommendations is associated with long-term effects on PPWR.
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              Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: a qualitative study.

              Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM. We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audiotaped and transcribed. Two investigators independently coded transcripts. We identified categories of themes and subthemes. Atlas.ti qualitative software (Berlin, Germany) was used to assist data analysis and management. Mean age was 31.5 years (standard deviation) [SD] 4.5), 63% were nonwhite, mean body mass index (BMI) was 25.9 kg/m(2) (SD 6.2), and 82% attended a postpartum visit. We identified four general themes that illustrated barriers and six that illustrated facilitators to postpartum follow-up care. Feelings of emotional stress due to adjusting to a new baby and the fear of receiving a diabetes diagnosis at the visit were identified as key barriers; child care availability and desire for a checkup were among the key facilitators to care. Women with recent GDM report multiple barriers and facilitators of postpartum follow-up care. Our results will inform the development of interventions to improve care for these women to reduce subsequent diabetes risk.
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                Author and article information

                Journal
                Int J Endocrinol
                Int J Endocrinol
                IJE
                International Journal of Endocrinology
                Hindawi Publishing Corporation
                1687-8337
                1687-8345
                2012
                25 March 2012
                : 2012
                : 519267
                Affiliations
                1Department of Internal Medicine, Seinäjoki Central Hospital, 60220 Seinäjoki, Finland
                2Physiology Department, Institute of Biomedicine, University of Eastern Finland, Kuopio Campus, 70211 Kuopio, Finland
                3Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, 70211 Kuopio, Finland
                4Department of Clinical Nutrition, Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio Campus, 70211 Kuopio, Finland
                5Department of Obstetrics and Gynecology, Kuopio University Hospital, 70211 Kuopio, Finland
                6Department of Internal Medicine, Central Finland Hospital District, 40620 Jyväskylä, Finland
                7Faculty of Health Sciences, University of Eastern Finland, Kuopio Campus, 70211 Kuopio, Finland
                Author notes
                *Eeva Korpi-Hyövälti: eeva.korpi-hyovalti@ 123456epshp.fi

                Academic Editor: Andrea Tura

                Article
                10.1155/2012/519267
                3320005
                22536233
                f4b9d654-4fd5-4cda-a5fd-3f3f6e759482
                Copyright © 2012 Eeva Korpi-Hyövälti et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 November 2011
                : 14 January 2012
                : 17 January 2012
                Categories
                Clinical Study

                Endocrinology & Diabetes
                Endocrinology & Diabetes

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