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Baptiste-Roberts K, Bronner Y, Nicholson WK. Adoption of a Healthy Lifestyle Following Gestational Diabetes Mellitus. Curr Nutr Rep 2015. [DOI: 10.1007/s13668-015-0135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cosson E, Bihan H, Vittaz L, Khiter C, Carbillon L, Faghfouri F, Leboeuf D, Dauphin H, Lepagnol A, Reach G, Valensi P. Improving postpartum glucose screening after gestational diabetes mellitus: a cohort study to evaluate the multicentre IMPACT initiative. Diabet Med 2015; 32:189-97. [PMID: 25393823 DOI: 10.1111/dme.12631] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 02/05/2023]
Abstract
AIMS To evaluate a mobilization campaign, the IMPACT initiative, which included multidisciplinary meetings, provision of information and a systematic prescription of an oral glucose tolerance test to improve the rate of glucose screening in women with gestational diabetes mellitus in the four largest maternity units in our area, starting in March 2011. METHODS We retrospectively compared the level of self-reported screening during the first 6 months postpartum of women who gave birth after having been diagnosed with gestational diabetes before (January 2009 to December 2010) and after the IMPACT campaign (April 2011 to February 2012). RESULTS We included 961 women (589 in the period before and 372 in the period after the campaign was initiated) with a mean ± SD age of 33.2 ± 5.3 years and BMI of 27.8 ± 5.3 kg/m². Multivariate analysis, stratified using a propensity score in order to limit bias caused by imbalance between both periods, showed that the postpartum screening rate was higher after the campaign began (48.9 vs 33.3%, odds ratio 1.7, 95% CI 1.1-2.5; P = 0.019) and higher in women who received insulin treatment during pregnancy (odds ratio 2.3, 95% CI 1.5-3.6; P < 0.001), consumed fruit and vegetables daily (odds ratio 1.6, 95% CI 1.1-2.4; P = 0.035) and did not smoke (smoking vs non-smoking: odds ratio 0.3, 95% CI 0.1-0.7; P = 0.01). There was no interaction between the campaign effect and these particular conditions. The proportion of oral glucose tolerance tests performed in women who underwent screening increased from 6.3 to 33.0%. CONCLUSIONS The IMPACT campaign increased postpartum screening, and the use the oral glucose tolerance test in particular. The effect of this initiative might be reinforced in women who are non-daily consumers of fruit and vegetables, smokers and those who do not receive insulin treatment during pregnancy.
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Affiliation(s)
- E Cosson
- AP-HP, Jean Verdier Hospital, Department of Endocrinology, Diabetology and Nutrition, Université Paris 13, Sorbonne Paris Cité, Bondy; Sorbonne Paris Cité, UMR U1153 Inserm / U1125 Inra / Cnam / Université Paris 13, Bobigny, France
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Bihan H, Cosson E, Khiter C, Vittaz L, Faghfouri F, Leboeuf D, Carbillon L, Dauphin H, Reach G, Valensi P. Factors associated with screening for glucose abnormalities after gestational diabetes mellitus: baseline cohort of the interventional IMPACT study. DIABETES & METABOLISM 2014; 40:151-7. [PMID: 24503190 DOI: 10.1016/j.diabet.2013.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although it is important to screen women who have had gestational diabetes mellitus (GDM) for abnormal post-partum glucose levels, such testing is rarely performed. The aim of this study was to use data from the first observational phase of the IMPACT study to determine rates of screening within 6 months of delivery in a multiethnic cohort, focusing in particular on the effects of social deprivation and the risk of future diabetes. PATIENTS AND METHODS To investigate the frequency of post-partum screening, charts were analyzed, and all women attending four centres located in a deprived area who had had GDM between January 2009 and December 2010 were contacted by phone. The Evaluation of Precarity and Inequalities in Health Examination Centres (EPICES) deprivation index and Finnish Diabetes Risk Score (FINDRISK) questionnaire were also evaluated. RESULTS Data were evaluable for 589 of the 719 women contacted (mean age: 33.4 ± 5.2 years; mean body mass index: 27.6 ± 5.4 kg/m(2)), and 196 (33.3%) reported having been screened. On multivariate analysis, factors associated with a lack of screening were smoking [odds ratio (OR): 0.42 (0.20-0.90), P<0.05], low consumption of fruit and vegetables [OR: 0.58 (0.39-0.82), P<0.01] and heavier offspring birth weight (P<0.05), although there were no differences in FINDRISK and EPICES scores between screened and unscreened women. CONCLUSION One-third of women who had had GDM reported having been screened for dysglycaemia at 6 months post-partum. However, it is expected that the interventional phase of the IMPACT study will increase screening rates, especially in women with the risk factors associated with lower screening rates during this observational phase.
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Affiliation(s)
- H Bihan
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Diabetology, Metabolic Diseases, CRNH-IdF, CINFO, Bobigny, France; Sorbonne Paris Cité, UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France.
| | - E Cosson
- Sorbonne Paris Cité, UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France; AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
| | - C Khiter
- De La Fontaine Hospital, Department of Obstetrics and Gynecology, Saint-Denis, France
| | - L Vittaz
- Ballanger Hospital, Department of Endocrinology-Diabetology, Aulnay-Sous-Bois, France
| | - F Faghfouri
- AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
| | - D Leboeuf
- Seine-Saint-Denis Private Hospital, Department of Obstetrics and Gynecology, Le Blanc Mesnil, France
| | - L Carbillon
- AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Gynaecology-Obstetrics, Bondy, France
| | - H Dauphin
- Ballanger Hospital, Department of Gynecology, Aulnay-Sous-Bois, France
| | - G Reach
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Diabetology, Metabolic Diseases, CRNH-IdF, CINFO, Bobigny, France
| | - P Valensi
- AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
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