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Preventive counseling among women with histories of gestational diabetes mellitus

¹Internal Medicine and Obstetrics & Gynecology, University of Michigan
²Division of Metabolism, Endocrinology, and Diabetes, University of Michigan
³Internal Medicine, University of Michigan Veterans Affairs Center
⁴Internal Medicine, Michigan Diabetes Research and Training Center
⁵Obstetrics & Gynecology, University of Michigan
⁶Division of Research, Kaiser Permanente Northern, California
⁷Oakland, California, Division of Metabolism, Endocrinology, and Diabetes, University of Michigan

cathkim{at}umich.edu

ABSTRACT

Objective: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 enrolled in a university-affiliated managed care plan. In a cross-sectional analysis, we assessed the association between recall of healthcare 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 OR 2.07, 95% CI 1.51-2.84) or claims data (adjusted OR 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. While 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.

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