Singapore women weigh in on postpartum glucose tolerance testing

Women remain reluctant to undergo a postpartum oral glucose tolerance test (OGTT) despite universal education regarding gestational diabetes mellitus (GDM), according to a recent Singapore study. Those who received specific recommendations from their prenatal care providers were much more likely to take a postpartum OGTT.

“Inherently, pregnant women are highly receptive to expert guidance because of the trust that they place in their caregivers,” the researchers said. “Essentially, such dependability appears to be an opportunity that antenatal care providers can use to leverage resources effectively to enhance the perception of the increased risk of type 2 diabetes mellitus (T2DM) associated with GDM.”

Using a prenatal questionnaire, the researchers conducted a cross-sectional survey of 216 women (mean age 32 years) diagnosed with GDM. Thirty participants were followed up postpartum with semi-structured interviews, with the goal of understanding the participants’ willingness to undergo early OGTT and receive lifestyle modification assistance.

Most (80.5 percent) of the survey respondents said that they had fair or good knowledge regarding T2DM, and 85.1 percent admitted that they thought they had a slight or moderate chance of developing the condition in the next 10 years. In general, the women acknowledged that having a history of GDM aggravated the future risk of T2DM. [Nutr Metab Insights 2021;14:11786388211016827]

During their pregnancies, 62.8 percent of women had been recommended by their prenatal care physicians to receive postpartum OGTT; 20.5 percent, on the other hand, had never heard about the test. In line with the recommendations, 63.0 percent of women felt that completing the OGTT was very important.

Nevertheless, despite high rates of physician recommendation and universal GDM education, as per public health standards in Singapore, only 73.2 percent of participants were planning to take the test.

Adjusted analyses revealed that GDM knowledge gained after the education clinic significantly improved the chances of a participant undergoing postpartum OGTT. Physician recommendations during pregnancy had a strong encouraging impact as well (odds ratio [OR], 4.01, 95 percent confidence interval [CI], 2.00–8.01).

In contrast, women of Malay ethnicity were much less likely to take the test (OR, 0.28, 95 percent CI, 0.12–0.69).

In terms of lifestyle, 69.8 percent of participants said that they were willing to receive behavioural support and assistance after childbirth. Those who completed the postpartum OGTT were much more open to receiving such help (OR, 3.46, 95 percent CI, 1.76–6.78), as were those who thought they had moderate to high risk of T2DM in the next 10 years (OR, 2.09, 95 percent CI, 1.10–3.94).

Notably, most of the women who were willing to receive postpartum lifestyle support preferred an app for mobile devices as the medium of assistance.

“As there are barriers that women face in the postpartum period, including a return to work, there is a need for an intervention that can be integrated into real life,” the researchers said. “The level of interest a woman has in reducing her T2DM risk is a promising start for early intervention to curb the growth of diabetes in Singapore. However, further studies with a large sample size are required to verify the current findings.”