Our systematic review of research into barriers and enablers
Around 12-13% of pregnant women worldwide are diagnosed with gestational diabetes (also known as GDM). GDM is a form of diabetes that happens during pregnancy and usually resolves after birth. Women with prior GDM are ten times more likely to develop type 2 diabetes (T2D) in the future than women without GDM.
There are steps that women can take after GDM to look after their health and reduce their risk of T2D. One of these is to check for T2D regularly to enable early detection. Recommendations include blood tests 6-12 weeks after birth, and ongoing screening every one to three years after. Detecting T2D early is important because it can help women get the care that they need and avoid health complications. However, research shows that only around half of women diagnosed with GDM go on to screen for T2D.
Previous studies have asked women with prior GDM what influences their uptake of T2D screening. Our aim was to review this research. We found 34 studies and summarised the findings below. We found three main themes:
Knowledge about diabetes risk and advice from health professionals are critical
We found that most women were aware of T2D screening but did not always understand their risk of T2D. This is important because understanding why screening is needed helps with motivation to attend.
Health professionals play an important role in providing information and they influence decisions about T2D screening. When health professionals do not talk about steps to take after GDM, this often leads to confusion about the need for T2D screening.
Competing demands can be a challenge, but social support and reminders can help
Finding time and remembering to attend T2D screening is a common challenge. This is because life with a new baby is busy and can be overwhelming. The T2D screening itself is also a barrier. This is because it can take a long time, and clinics are not always set up for babies and young children. On top of this, women often place the needs of their children and family before their own. This makes it challenging to priorities T2D screening.
Social support helps women to overcome practical barriers. For example, family and friends who are available to take care of children during the appointment. Reminders are also useful for remembering to attend T2D screening.
Emotions, self-confidence, and beliefs play a role
Emotions and self-confidence sometimes influence whether women want to know if they have developed T2D. For example, some women did not attend due to fear of having diabetes or a lack of confidence in their ability to prevent or manage diabetes.
Beliefs also played a role. We found that believing that T2D screening is important for health motivates women to attend. Some beliefs can be barriers. For example, some women believe that T2D screening is not urgent if they don’t have any symptoms. Others think they may not need to screen if they are looking after their health through healthy habits and they self-monitor their blood glucose. However, it is important to know that T2D rarely has early symptoms. While healthy habits and monitoring glucose are useful, formal screening is currently the best way to find out if you have T2D.
Our review found screening for T2D after GDM is influenced by knowledge, competing demands, social support, beliefs, emotions, and self-confidence. This is useful because we now know more about the factors that affect ability, opportunity, and motivation to screen, and where more support is needed. These findings can be used to develop messages that address these factors to help encourage more women with prior GDM to screen for T2D.
If you would like to know more about steps to a healthy life after GDM, check out the NDSS resource ‘Life after gestational diabetes’.
Or, check out our other blogs on gestational diabetes and type 2 diabetes.
Citation: Lake AJ, Neven ACH, Williams A, O’Reilly SL, Hendrieckx C, Morrison M, Dunbar J, Teede H, Boyle JA, Speight J on behalf of the ME-MaGDA study group. Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A systematic review update and qualitative synthesis applying the Theoretical Domains Framework. Diabetic Med. 2021 Dec 25: e14772. doi:10.1111/dme.14772
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