Skip to main content

Advertisement

Log in

Navigating a ‘Perfect Storm’ on the Path to Prevention of Type 2 Diabetes Mellitus After Gestational Diabetes: Lessons from Patient and Provider Narratives

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives Complications of pregnancy such as gestational diabetes mellitus (GDM) forewarn future chronic illness and disability, and demonstrate the need for a life course approach to prevention. Our study had two aims: (1) to elucidate how experiences reported by patients and providers converge to facilitate or impede follow-up care after GDM, and (2) to elicit recommendations for system-level changes to enhance prevention across key care transitions. Methods We conducted in-depth interviews with 30 GDM patients and 29 providers of maternity, specialty and primary care in an urban safety hospital network, and used a three-tiered thematic analysis to interpret their narratives. Results Findings reveal that a ‘perfect storm’ gathers on the path to prevention across stages of care. At diagnosis, patients feel profound anxiety about the debilitating effects of type 2 diabetes mellitus in their communities, providers choose reassurance over risk communication, and both focus primarily on the birth of a healthy baby. Providers report that clinical teams often lack coordination, and confuse patients with a barrage of often-inconsistent advice. In the postpartum period, providers juggle competing clinical priorities and mothers juggle overwhelming demands; for both, the recommended 2-h oral glucose tolerance test is too arduous for women and providers to do as prescribed. Finally, the transition from maternity to primary care is complicated by communication barriers between clinicians and patients, and between maternity and primary care providers. Conclusions for Practice Respondents propose systems innovations to open communication between provider specialties in order to bridge the chasm between reproductive care and life course prevention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • American Congress of Obstetricians and Gynecologists. (2013). ACOG practice bulletin. Gestational diabetes. Obstetrics and Gynecology, 122, 406–416.

    Article  Google Scholar 

  • American Congress of Obstetricians and Gynecologists. (2018). ACOG committee opinion number 736. Presidential Task Force on Redefining the Postpartum Visit.

  • American Diabetes Association. (2004). Gestational diabetes mellitus. Diabetes Care, 27, S88–S90.

    Article  Google Scholar 

  • American Diabetes Association. (2017). Standards of medical care in diabetes: Management of diabetes in pregnancy. Diabetes Care, 40, S114–S119.

    Article  Google Scholar 

  • Bennett, W., Ennen, C., Carrese, J., Hill-Briggs, F., Levine, D., Nicholson, W., et al. (2011). Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: A qualitative study. Journal of Women’s Health, 20, 239–245.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bennett, W. L., Chang, H. Y., Levine, D. M., Wang, L., Neale, D., Werner, E. F., et al. (2014). Utilization of primary and obstetric care after medically complicated pregnancies: An analysis of medical claims data. Journal of General Internal Medicine, 29, 636–645.

    Article  PubMed  PubMed Central  Google Scholar 

  • Carson, M. P., Frank, M. I., & Keely, E. (2013). Postpartum testing rates among women with a history of gestational diabetes: Systematic review. Primary Diabetes Care, 7, 177–186.

    Article  Google Scholar 

  • Clancy, C. M., & Massion, C. T. (1992). American women’s health care: A patchwork quilt with gaps. Journal of the American Medical Association, 268, 1918–1920.

    Article  CAS  PubMed  Google Scholar 

  • Clark, H. D., Graham, I. D., Karovitch, A., & Keely, E. J. (2009). Do postal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus? A randomized control trial. American Journal of Obstetrics and Gynecology, 200, 634 e1–634 e7.

    Article  Google Scholar 

  • Collins, J. L., Lehnherr, J., Posner, S. F., & Toomey, K. E. (2009). Ties that bind: Maternal and child health and chronic disease prevention at the Centers for Disease Control and Prevention. Preventing Chronic Disease, 6, 1–6.

    Google Scholar 

  • Dabelea, D., Hanson, R. L., Lindsay, R. S., Pettitt, D. J., Imperatore, G., Gabir, M. M., et al. (2000). Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: A study of discordant sibships. Diabetes, 49(12), 2208–2211.

    Article  CAS  PubMed  Google Scholar 

  • Dabelea, D., Snell-Bergeon, J. K., Hartsfield, C. L., Bischoff, K. J., Hamman, R. F., & McDuffie, R. S. (2005). Increasing prevalence of gestational diabetes mellitus (GDM) over time and by birth cohort. Diabetes Care, 28, 579–584.

    Article  PubMed  Google Scholar 

  • Friedberg, M. W., Schneider, E. C., Rosenthal, M. B., Volpo, K. G., & Werner, R. M. (2014). Association between participation in a multi-payer medical home intervention and changes in quality, utilization, and costs of care. Journal of the American Medical Association, 311, 815–825.

    Article  CAS  PubMed  Google Scholar 

  • Glaser, B., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine DeGruyter.

    Google Scholar 

  • Homer, C. J., Klatka, K., Romm, D., Kuhlthau, K., Bloom, S., Newacheck, P., et al. (2008). A review of the evidence for the medical home for children with special health care needs. Pediatrics, 122, e922–e937.

    Article  PubMed  Google Scholar 

  • Ickovics, J. R., Kershaw, T. S., Westdahl, C., Magriples, U., Massey, Z., Reynolds, H., et al. (2007). Group prenatal care and perinatal outcomes. Obstetrics and Gynecology, 110, 330–339.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kim, C., Berger, D. K., & Chamany, S. (2007). Recurrence of gestational diabetes: A systematic review. Diabetes Care, 30, 1314–1319.

    Article  PubMed  Google Scholar 

  • Kim, C., Newton, K. M., & Knopp, R. H. (2002). Gestational diabetes and the incidence of type 2 diabetes. Diabetes Care, 25, 1862–1868.

    Article  PubMed  Google Scholar 

  • Lu, M. C., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., & Halfon, N. (2010). Closing the black-white gap in birth outcomes: A life-course approach. Journal of Racial and Ethnic Health Disparities, 20, 61–76.

    Google Scholar 

  • Martinez, N. G., Charlotte, C. M., & Yee, L. (2017). Optimizing postpartum care for the patient with gestational diabetes mellitus. American Journal of Obstetrics & Gynecology. https://doi.org/10.1016/j.ajog.2017.04.033.

    Article  Google Scholar 

  • McCloskey, L., Bernstein, J., Winter, M., Iverson, R., & Lee-Parritz, A. (2014). Follow-up of gestational diabetes mellitus in an urban safety net hospital: Missed opportunities to launch preventive care for women. Journal of Women’s Health, 23, 327–334.

    Article  PubMed  PubMed Central  Google Scholar 

  • National Committee for Quality Assurance. (2013). Patient-centered medical homes [fact sheet]. Retrieved from https://www.ncqa.org/Portals/0/Newsroom/2013/pcmh%202011%20fact%20sheet.pdf.

  • Oza-Frank, R., Ko, J. Y., Wagner, A., Rodgers, L., Bouchard, J. M., & Conrey, E. J. (2014). Improving care for women with a history of gestational diabetes: A provider perspective. Maternal and Child Health Journal, 18, 1683–1690.

    Article  PubMed  Google Scholar 

  • Paez, K. A., Eggleston, E. M., Griffey, S. J., Farrar, B., Smith, J., Thompson, J., et al. (2014). Understanding why some women with a history of gestational diabetes do not get tested for diabetes. Women’s Health International, 24, e373–e379.

    Article  Google Scholar 

  • Pies, C., & Kotelchuck, M. (2013). Bringing the MCH life course perspective to life. Maternal and Child Health Journal, 18, 335–338.

    Article  Google Scholar 

  • Ratner, R. E., Christophi, C. A., Metzger, B. E., Dabelea, D., Bennett, P. H., Pi-Sunyer, X., et al. (2008). Prevention of diabetes in women with a history of gestational diabetes: Effects of metformin and lifestyle interventions. Journal of Clinical Endocrinology and Metabolism, 93, 4774–4779.

    Article  CAS  PubMed  Google Scholar 

  • Rice, P. L., & Ezzy, D. (1999). Qualitative research methods: A health focus. Oxford: Oxford University Press.

    Google Scholar 

  • Shah, B. R., Lipscombe, L. L., Feig, D. S., & Lowe, J. M. (2011). Missed opportunities for type 2 diabetes testing following gestational diabetes: A population-based cohort study. British Journal of Obstetrics and Gynecology, 118, 1484–1490.

    Article  CAS  Google Scholar 

  • Shai, I., Jiang, R., Manson, J. E., Stampfer, M. J., Willett, W. C., Colditz, G. S., et al. (2006). Ethnicity, obesity and risk of type 2 diabetes in women: A 20 year follow-up study. Diabetes Care, 29, 1585–1590.

    Article  PubMed  Google Scholar 

  • Steub, A., Ecker, J., Bates, D., Zera, C., Bentley-Lewis, R., & Seely, E. (2010). Barriers to follow-up for women with a history of gestational diabetes. American Journal of Perinatology, 27, 705–710.

    Article  Google Scholar 

  • Thorne, S. (2008). Interpretive description. Walnut Creek: Left Coat Press.

    Google Scholar 

  • Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19, 349–357.

    Article  PubMed  Google Scholar 

  • Van Ryswyk, E. M., Middleton, P., Shute, E., Hague, W. M., & Crowther, C. A. (2015a). Women’s views and knowledge regarding healthcare seeking for gestational diabetes in the postpartum period: A systematic review of qualitative/survey studies. Diabetes Research and Clinical Practice, 110, 109–122.

    Article  PubMed  Google Scholar 

  • Van Ryswyk, E. M., Middleton, P. F., Hague, W. M., & Crowther, C. A. (2014). Clinicians’ views and knowledge regarding healthcare provision in the postpartum period for women with recent gestational diabetes: A systematic review of qualitative/survey studies. Diabetes Research and Clinical Practice, 106, 401–411.

    Article  PubMed  Google Scholar 

  • Van Ryswyk, E. M., Middleton, P. F., Hague, W. M., & Crowther, C. A. (2015b). Postpartum SMS reminders to women who have experienced gestational diabetes to test for type 2 diabetes: The DIAMIND randomized trial. Diabetic Medicine, 32(10), 1368–1376.

    Article  CAS  PubMed  Google Scholar 

  • Walker, L. O., Murphey, C. L., & Nichols, F. (2015). The broken thread of health promotion and disease prevention for women during the postpartum period. Journal of Perinatal Education, 24, 81–92.

    Article  PubMed  Google Scholar 

  • Yee, L., Martinez, N. G., Nguyen, A. T., Hajjar, N., Chen, M., & Simon, M. (2017). Using a patient navigator to improve postpartum care in an urban women’s health clinic. Obstetrics & Gynecology, 129, 925–933.

    Article  Google Scholar 

  • Zapka, J. G., Puleo, E., Taplin, S. H., Goins, K. V., Yood, M. U., Mouchawar, J. et al. (2004). Processes of care in cervical and breast cancer screening and follow-up: The importance of communication. Preventive Medicine, 39, 81–90.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful for the generosity of the 30 women interviewed during the months following the birth of their child, the 29 clinicians interviewed, and the team of research assistants who skillfully conducted the in-depth interviews in diverse settings and languages. We specifically wish to acknowledge the interviewing and management contribution made by Dr. Judy N. Margo.

Funding

This work was supported in part by NICHD R21-HD75640.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lois McCloskey.

Ethics declarations

Conflict of interest

No competing financial interests exist.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McCloskey, L., Sherman, M.L., St. John, M. et al. Navigating a ‘Perfect Storm’ on the Path to Prevention of Type 2 Diabetes Mellitus After Gestational Diabetes: Lessons from Patient and Provider Narratives. Matern Child Health J 23, 603–612 (2019). https://doi.org/10.1007/s10995-018-2649-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-018-2649-0

Keywords

Navigation