Primary care management of risk of type 2 diabetes in women with a history of gestational diabetes

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cam.restrictionthesis_access_open
cam.supervisorGriffin, Simon
cam.supervisorUsher-Smith, Juliet
cam.supervisor.orcidGriffin, Simon [0000-0002-2157-4797]
cam.supervisor.orcidUsher-Smith, Juliet [0000-0002-8501-2531]
dc.contributor.authorDennison, Rebecca
dc.contributor.orcidDennison, Becky [0000-0002-0847-0723]
dc.date.accessioned2021-03-09T12:24:38Z
dc.date.available2021-03-09T12:24:38Z
dc.date.submitted2020-09-01
dc.description.abstractThis thesis aims to inform strategies to improve care for mothers after a pregnancy affected by gestational diabetes (GD) in relation to risk of type 2 diabetes (T2D) after delivery. Through a systematic review (including 129 studies of 310,214 women with GD, Study 1) and study-level meta-regression, I highlighted that a third of women developed T2D within 15 years of GD a pregnancy. Progression was higher in non-White European populations compared to other populations, and in those with higher BMI at follow-up. These findings emphasised the need for both sustained follow-up after GD through screening, and interventions to reduce modifiable risk factors. Currently, screening for T2D is recommended at six to 13 weeks after a GD pregnancy, then subsequently at regular intervals. Consistent with other studies, I identified that 25.4% patients (n=556) did not undergo a postpartum test at a local hospital between 2014 and 2017 (Study 2). It is also known that many mothers find it challenging to maintain a healthy lifestyle after a GD pregnancy, and do not make changes to their diet or activity levels to reduce their risk. To explore reasons for this, I conducted two qualitative systematic reviews and developed 30 recommendations to promote screening attendance, healthy diet and physical activity based on the findings (Studies 3 and 4). I then elicited an evaluation of these recommendations from 20 mothers with previous GD (Study 5), in addition to their own ideas for improving postpartum support. Lifestyle advice amid a busy schedule and tips for sustaining changes, along with flexibility in screening appointments and invitations, were welcomed. I have highlighted that women with GD are an easily-identifiable group at high risk of T2D, and there is a need for interventions to manage this risk. I have provided evidence to support and inform such interventions during pregnancy and postpartum, which could include feasible adaptation to current practice, to improve care.
dc.description.sponsorshipThis project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR; SPCR-S-S102). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
dc.identifier.doi10.17863/CAM.65673
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/318560
dc.publisher.institutionUniversity of Cambridge
dc.rightsAll Rights Reserved
dc.rights.urihttps://www.rioxx.net/licenses/all-rights-reserved/
dc.subjectPrimary care
dc.subjectGestational diabetes
dc.subjectType 2 diabetes
dc.subjectPrevention
dc.titlePrimary care management of risk of type 2 diabetes in women with a history of gestational diabetes
dc.typeThesis
dc.type.qualificationlevelDoctoral
dc.type.qualificationnameDoctor of Philosophy (PhD)
dc.type.qualificationtitlePrimary Care Research
rioxxterms.licenseref.urihttps://www.rioxx.net/licenses/all-rights-reserved/
rioxxterms.typeThesis
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