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Preventive Counseling Among Women With Histories of Gestational Diabetes Mellitus

¹ Departments of Internal Medicine and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
² Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, Michigan
³ Department of Internal Medicine, University of Michigan Veterans Affairs Center, Ann Arbor, Michigan
⁴ Department of Internal Medicine, Michigan Diabetes Research and Training Center, Ann Arbor, Michigan
⁵ Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
⁶ Division of Research, Kaiser Permanente Northern, California, Oakland, California

Address correspondence and reprint requests to Catherine Kim, MD, MPH, 300 NIB, Room 7C13, Box 0429, Ann Arbor, MI 48109. E-mail: cathkim{at}umich.edu

OBJECTIVE—The purpose of this study was to examine the association between recall of recommendations for diabetes prevention and both health behaviors and screening among women with histories of gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS—We surveyed 228 women with histories of GDM within the past 5 years who were enrolled in a university-affiliated managed care plan. In a cross-sectional analysis, we assessed the association between recall of health care provider advice and both postpartum lifestyle behaviors and reported performance of postpartum diabetes screening. Multivariate models were constructed that adjusted for correlates of counseling including postpartum diabetes, dyslipidemia, insulin use during pregnancy, and provider type.

RESULTS—Participants were predominantly non-Hispanic white, college educated and affluent, and overweight or obese. The majority reported that they received counseling on lifestyle modification and postpartum diabetes screening. Postpartum physical activity levels, fruit and vegetable intake, and screening were suboptimal. No significant association existed between recall of advice and physical activity or between recall of advice and diet. Recall of advice along with distribution of laboratory slips for glucose testing was associated with performance of postpartum diabetes screening using self-report (adjusted odds ratio 2.07 [95% CI 1.51–2.84]) or claims data (1.64 [1.16–2.32]).

CONCLUSIONS—Women with histories of GDM who recalled advice regarding postpartum glucose testing and received laboratory slips were significantly more likely to report having had postpartum diabetes screening. Although women's recall of services may not reflect the actual services received, simple counseling may not be sufficient to optimize postpartum behaviors to reduce future risk of diabetes.

Abbreviations: GDM, gestational diabetes mellitus • OGTT, oral glucose tolerance test

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