gms | German Medical Science

Background: Gestational diabetes mellitus (GDM) is the most common metabolic disturbance during pregnancy. Depending on the database and definition, the prevalence varies between 4% and 20%. Epidemiological studies show that women with GDM have a higher risk of developing type 2 diabetes later in life.

Therefore, the aftercare for women affected by GDM is important und formulated in the German S3-Guideline “Gestational Diabetes Mellitus (GDM) – Diagnosis, Treatment and Follow-Up”. However, it is unclear whether and to what extent the guidelines’ recommendations are implemented and in line with the actual care in practice. Especially, the procedures and the interaction between the different care providers have not been adequately studied, even though available evidence suggests that under-, over- and misuse exist in parallel.

With their advice and care, midwives can make a significant contribution for women after gestational diabetes in their postnatal care.

Aim: The aim of the project “Aftercare for gestational diabetes” (GestDiNa_basic) is to map and analyse the aftercare of women with GDM in Germany and to develop suggestions for the further development of patient-centred adequate care. As part of the study, knowledge, attitudes and action routines of midwives regarding the aftercare of women after GDM are determined. Preventative measures from the midwife’s range of activities, such as promoting breastfeeding, are also recorded and evaluated.

Methods: The study design is based on different data sources using a mixed-method approach. Knowledge, awareness, attitudes, routines and experiences of women affected by GDM and the care providers involved are collected and analysed through a quantitative and qualitative research approach. Other important data sources are billing data from various health insurance companies and the Association of Statutory Health Insurance Physicians of North Rhine as well as data from the German GestDiab Register – Diabetes in pregnancy. The analysis is carried out quantitatively using descriptive statistics as well as various regression models and qualitatively using content analysis in multi-professional evaluation groups. In addition to the participating general practitioners and specialists, 100 midwives offering out-of hospital postnatal care were also contacted as part of the quantitative survey.

Results: The first results of the quantitative partial examination of midwives (n=33) show that almost every second of the responding midwives feel unsure about GDM aftercare. Almost 82% strongly or somewhat agreed with the statement that they find it useful to offer postpartum diabetes screening (including an oral glucose tolerance test/75 g-OGTT) to women after GDM. In this regard, however, it is noteworthy that some of the midwives who gave their consent did not refer to this test option at any time during their care.

Relevancy: The research project provides relevant, currently largely missing or insufficient data on aftercare for GDM in Germany. Health and care policy decisions can be made based on this data.

Recommendations/Conclusion: The results can contribute to the development of an appropriate, effective and patient-centred healthcare model that can be evaluated in subsequent projects.

Ethics and conflicts of interest: A vote on ethics was obtained. The research was supported by external funding. There are no conflicts of interest.