Amanda Björk Javanshiri - Institutionen för kliniska vetenskaper, Malmö

Title: Gestational diabetes and lifestyle habits in primary care.

Main supervisor: Susanna Calling, specialist in family medicine and associate professor Lund University.

Reviewers: Margareta Hellgren, specialist in family medicine and associate professor Skaraborgsinstitutet. Helena Strevens, senior specialist in obstetrics and gynecology and associate professor Lund University.

Abstract

Background

Gestational diabetes mellitus (GDM) is associated with an increased risk of typ-2 diabetes (T2DM) and cardiovascular disease (CVD) later in life. Lifestyle interventions promoted by primary care can considerably reduce this risk. However, preventive resources are limited, and therefore digital tools have been suggested as a promising solution. Thus, there is a need to study the follow-up of women with previous GDM and also investigate whether digital devices potentially can reduce CVD-risk in primary care.

Research questions

1. Are women with previous GDM offered follow-up in primary care, according to national guidelines?
2. What are the experiences of GDM diagnosis and prenatal health care in women with a history of GDM?
3. What are the experiences among GDM-women of follow-up in primary care, treatment with lifestyle interventions as well as their views on the use of digital tools in this regard?
4. Can a health-promoting text message intervention affect CVD risk factors in patients with hypertension?

Preliminary results

Paper 1: The follow-up of women with previous GDM in primary care was lacking and did not correspond with national guidelines.

Paper 2: One comprehensive theme emerged: to suddenly become a patient as opposed to an expectant mother. GDM women requested additional information, emotional support, and an increased understanding of the treatment burden of GDM from healthcare personnel, as well as improved person-centered care and collaboration between healthcare providers.

Paper 3: GDM women felt abandoned after labor since the follow-up in primary care was lacking. The future risk of T2DM was the strongest motivator for healthy lifestyle behaviors. Overall, they had a positive attitude toward digital solutions in facilitating follow-up and supporting lifestyle change. 

Significance

To improve lifestyle habits and reduce CVD risk in high-risk populations, it is of importance to study disease prevention with lifestyle intervention in primary care. Ultimately improved care would be beneficial not only for these patients’ health but also from a health economic perspective. 

Published studies

Björk Javanshiri A, Calling S, Modig S. Follow-up and screening for type-2 diabetes mellitus in women with previous gestational diabetes in primary care. Scand J Prim Health Care. 2023;41(1):98-103.