Implementation of a new program of gestational diabetes screening and management in Morocco: a qualitative exploration of health workers' perceptions

Oral glucose tolerance test-The imperfect gold standard for gestational diabetes screening: A qualitative study involving clinicians in regional, rural and remote areas of Western Australia

ISSUE ADDRESSED

The oral glucose tolerance test is the 'gold standard' for detecting gestational diabetes in Australian and International guidelines. Test completion in regional, rural and remote regions may be as low as 50%. We explored challenges and enablers for regional, rural and remote antenatal clinicians providing gestational diabetes screening to better understand low oral glucose tolerance test completion.

METHODS

We conducted a qualitative descriptive study using semi-structured interviews. Participants eligible for the study were doctors or midwives providing antenatal care in regional, rural and remote Western Australia, between August 2019 and November 2020. Interviews were recorded digitally and transcribed into a Word document. We conducted a thematic analysis after initial categorisation and deduction of themes through workshops involving the research team.

RESULTS

We found a diversity of viewpoints on oral glucose tolerance test reliability for detecting gestational diabetes. Themes that emerged were; good collaboration between antenatal clinicians is required for successful screening; screening occurs throughout pregnancy using various tests; clinicians make significant efforts to address barriers; clinicians prioritise therapeutic relationships.

CONCLUSIONS

Effective universal screening for gestational diabetes in regional, rural and remote Western Australia is difficult and more complex in practice than guidelines imply. Detecting gestational diabetes requires creative solutions, early identification of at risk women and trust and collaboration between clinicians and women. SO WHAT?: Detection of gestational diabetes in regional, rural and remote Western Australia remains poorly completed. New strategies are required to adequately identify women at risk of adverse birth outcomes relating to hyperglycaemia in pregnancy.

Scoping Review to Identify Social Determinants of Maternal Health in Morocco

To understand the mechanism of health inequities and their influence on maternal health, the Commission on Social Determinants of Health (CSDH) provides a framework to identify structural and intermediate causes of health inequity. This review maps and describes the current socioeconomic determinants of maternal health in Morocco according to the CSDH framework. A scoping study was carried out from six databases (Springer, Web of Science, Pubmed, Science Direct, Jstor, and Cochrane library) based on quantitative and qualitative research done since 1990. Structural factors such as women's employment and economic status, education level, culture, and gender equity were influenced by intermediary factors such as place of residence, age at marriage, maternal age at childbirth, and parity (either alone or in conjunction with other variables). Together these factors worked to influence maternal health service usage or affected maternal health outcomes. Power dynamics were identified in a variety of social situations that impacted access to health care for women across socioeconomic categories. Studies reveal how social determinants impact maternal health in Morocco. Addressing these determinants is required for sustainably improving maternal and infant health in Morocco.

Exploring patients' perspectives of gestational diabetes mellitus screening and counselling in Ontario: A grounded theory study

INTRODUCTION

Gestational diabetes mellitus (GDM) is associated with adverse perinatal outcomes. Approaches to screening for GDM continue to evolve, introducing potential variability of care. This study explored the impact of these variations on GDM counselling and screening from the perspectives of pregnant individuals.

METHODS

Following a Corbin and Strauss approach to qualitative, grounded theory we recruited 28 individuals from three cities in Ontario, Canada who had a singleton pregnancy under the care of either a midwife, family physician or obstetrician. Convenience and purposive sampling techniques were used. Semi-structured telephone interviews were conducted and transcribed verbatim between March and December 2020. Transcripts were analysed inductively resulting in codes, categories and themes.

RESULTS

Three themes were derived from the data about GDM screening and counselling: 'informing oneself', 'deciding' and 'screening'. All participants, regardless of geographical region, or antenatal care provider, moved through these three steps during the GDM counselling and screening process. Differences in counselling approaches between pregnancy care providers were noted throughout the 'informing' and 'deciding' stages of care. Factors influencing these differences included communication, healthcare autonomy and patient motivation to engage with health services. No differences were noted within care provider groups across the three geographic regions. Participant experiences of GDM screening were influenced by logistical challenges and personal preferences towards testing.

CONCLUSION

Informing oneself about GDM may be a crucial step for facilitating decision-making and screening uptake, with an emphasis on information provision to facilitate patient autonomy and motivation.

PATIENT OR PUBLIC CONTRIBUTION

Participants of our study included patients and service users. Participants were actively involved in the study design due to the qualitative, patient-centred nature of the research methods employed. Analysis of results was structured according to the emergent themes of the data which were grounded in patient perspectives and experiences.

Midwifery awareness of diabetes in pregnancy screening guidelines in Aotearoa New Zealand

OBJECTIVE

Effective and timely management of gestational diabetes mellitus (GDM) requires early detection. However, screening rates have been shown to be relatively low in New Zealand, despite the introduction of national screening guidelines in 2014 which indicate that all pregnant women should be screened. Thus, the aim of this study was to explore the awareness of the New Zealand Ministry of Health Diabetes in Pregnancy screening guidelines by New Zealand midwives.

DESIGN

A 24-question online survey based upon the New Zealand screening guidelines was distributed via New Zealand midwifery social media groups to explore the awareness of New Zealand midwives with regard to screening for diabetes in pregnancy. Free text comments were also allowed, these were broadly categorized and reviewed.

PARTICIPANTS

174 registered midwives in Aotearoa New Zealand completed the survey.

MEASUREMENTS AND FINDINGS

All participants responded that they routinely offer glycated haemoglobin screening for detection of undiagnosed pre-gestational diabetes, and 92.9% identified that this should occur prior to 20 weeks gestation (as per the national guidelines). However, less than two thirds of midwives thought that all women should be screened for GDM, with 18.2% indicating they would only do this if immediate risk factors were present. There also appeared to be some confusion over the time period for screening for GDM with 22.9% indicating that this should occur later than the guideline-recommended timepoint of 24-28 weeks gestation. Participants who identified as Māori and community-based midwives were most likely to screen for GDM 'only if risk factors were present'. Participants practicing for more than 6 years, those aged 45-54 years, and midwives identifying as Māori were most likely to screen for GDM after 28 weeks (though these did not reach statistical significance).

KEY CONCLUSIONS

The New Zealand Diabetes in Pregnancy screening guidelines do not appear to be well implemented in our sample group, particularly with regard to screening for GDM. This needs to be evaluated in a larger group of midwives, as education around the timeliness and importance of screening for all women may be required.

IMPLICATIONS FOR PRACTICE

A lack of appropriate or timely screening for GDM may mean that women are not being diagnosed or managed appropriately, which in turn may have implications for both mother and child.

Interpretation of maternal blood glucose during pregnancy at high altitude area, Abha-Saudi Arabia

Background and Aims:

In women who reside at high altitude, fasting plasma glucose is lower than at sea level, and further decrease of fasting blood glucose was noticed during pregnancy. This study aimed to set cutoff level of fasting plasma glucose during pregnancy at high altitude. The obtained data intended for interpretation of gestational blood sugar results and early detection of those who at risk of developing gestational diabetes.

Methods:

A cross-sectional study was conducted to determine the cutoff level of fasting plasma glucose during pregnancy at high altitude. The subjects were pregnant women who attending the routine antenatal care at Abha Maternity Hospital and Mahayil Aseer Maternity hospital. Plasma glucose concentrations and Body Mass Index (BMI), socio-demographic and obstetric data were entered into the Statistical Package for Social Sciences (SPSS) version 20. Comparison amongst these variables were carried out through t test (numerical variables) and Chi Square test (proportions). A P value of <0.05 was considered as statistically significant.

Results:

The overall results obtained indicated that the fasting plasma glucose concentrations and BMI were significantly lower (p = 0.0001) at high altitude area (Abha) than low altitude area (Mahayil Aseer). Age was the only socio-demographic factor that showed significant difference between the two groups (p-value was <0.05).

Conclusion:

Up to our knowledge, this is the first study addressing the interpretation of fasting blood glucose during pregnancy at high altitude area in Saudi Arabia. Our findings support the importance of careful interpretation of fasting blood glucose of pregnant women who reside at high altitude areas. The implementation of this policy at high altitude areas in the Kingdom of Saudi Arabia is recommended for early detection of gestational diabetes and timed intervention to avoid complications.