Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes.

BACKGROUND: Postpartum screening for diabetes in women with gestational diabetes (GDM) improves with use of reminder systems. Our primary objective was to identify predictors of diabetes screening in the first year after delivery. METHODS: A retrospective study was performed of 556 women with GDM who received outpatient prenatal care between 2007 and 2009. A mailed reminder system was utilized at two sites. Rates of postpartum glucose testing at 6 and 12 months postpartum were measured. RESULTS: Site of care and non-smoking status were identified as the only predictors of postpartum diabetes screening (p<0.001 and p = 0.02, respectively). Rates of OGTT completion at one year (38% vs. 19% p<0.001) were higher in women who attended clinics with postpartum reminders. CONCLUSIONS: The site of diabetes care in pregnancy is a major predictor of adherence to diabetes screening postpartum. Health care delivery should be considered in the development of strategies to increase screening rates.

Obstetric healthcare providers' perceptions of communicating gestational weight gain recommendations to overweight/obese pregnant women.

BACKGROUND: Gestational weight gain (GWG) is a major risk factor of poor pregnancy outcomes. Obese pregnant women frequently report bias and discrimination when dealing with healthcare providers (HCPs). Effective communication of GWG recommendations may impact risks. Study objectives were to identify perceptions of HCPs in communicating GWG recommendations and to identify potential gaps/opportunities that could be addressed in the development of appropriate materials/programmes. METHODS: A survey tool was created using the Theory of Planned Behaviour to capture HCPs' attitudes, behaviours and intentions, using four-point Likert questions. Surveys were distributed to obstetricians/gynaecologists, family physicians, obstetric residents/ fellows, midwives, registered/public health nurses and registered dietitians. RESULTS: Results from 96 surveys show that HCPs agreed discussing GWG was important (100%), beneficial for patient-provider rapport (86%) and best practice (100%); however, most found it unpleasant (68%). Providers have confidence in their skills to provide nutrition advice (71%) and believe they have sufficient training (56%); yet, 31% acknowledged making derogatory comments and indicated that they could improve their communication of GWG (92%). CONCLUSIONS: HCPs believe they are providing GWG recommendations in an effective and empathetic manner. While an underlying current of bias/discrimination remains, there is recognition of the importance of more training and access to appropriate tools.