Phaloprakarn Chadakarn, Suthasmalee Sasiwan
Faculty of Medicine Vajira Hospital, Department of Obstetrics and Gynecology, Navamindradhiraj University, Bangkok, Thailand.
Faculty of Medicine Vajira Hospital, Department of Obstetrics and Gynecology, Navamindradhiraj University, Bangkok, Thailand.
Am J Obstet Gynecol MFM. 2023 Oct;5(10):101107. doi: 10.1016/j.ajogmf.2023.101107. Epub 2023 Jul 30.
Postpartum visit attendance for glucose screening and uptake of effective contraception is crucial after a pregnancy with gestational diabetes mellitus. Although postpartum women with recent gestational diabetes mellitus are generally advised in the early postnatal period to attend postpartum visits, data have shown suboptimal rates of postpartum glucose testing and of highly effective contraceptive use among these women. Compared with the early postnatal period, the antenatal period is when women and healthcare providers have more contact. This may facilitate a better relationship between the pregnant woman and her healthcare providers, thereby improving the women's trust in the providers' counseling.
This study aimed to investigate if adding prenatal counseling to routine, early-postnatal counseling increases the rates of glucose screening and contraceptive use by 6 weeks postpartum among pregnant women with gestational diabetes mellitus.
A randomized controlled trial of 280 women diagnosed with gestational diabetes mellitus was conducted. Participants were randomly allocated (1:1, stratified using a permuted block method) to the intervention group (receiving prenatal counseling at 35-36 weeks of gestation plus routine, early-postnatal counseling) or the control group (receiving only routine, early-postnatal counseling). The 2 primary outcomes were glucose screening and highly effective contraceptive uptake by 6 weeks postpartum. The secondary outcome was the use of any contraceptive by 6 weeks postpartum. Data were analyzed according to the intention-to-treat principle.
The rate of postpartum glucose screening was 86.4% (121/140) in the intervention group, which was significantly higher than the rate of 50.7% (71/140) in the control group (adjusted relative risk, 1.70; 95% confidence interval, 1.27-2.28). The uptake of highly effective contraceptive methods was increased in the intervention group when compared with the control group (59.3% vs 30.7%; adjusted relative risk, 1.90; 95% confidence interval, 1.31-2.74). The uptake of any contraceptive method by 6 weeks postpartum was reported by 122 of 140 participants (87.1%) in the intervention group and by 77 of 140 participants (55.0%) in the control group (adjusted relative risk, 1.58; 95% confidence interval, 1.19-2.10).
Adding prenatal counseling to routine, early-postnatal counseling significantly increased the rates of glucose screening and contraceptive use by 6 weeks postpartum among pregnant women with gestational diabetes mellitus. Given that the incorporation of counseling on postpartum glucose testing and effective contraceptive use into standard prenatal care requires minimal increases in expenditure and manpower, implementation of this counseling strategy in clinical practice seems advisable.
对于患有妊娠期糖尿病的孕妇，产后进行葡萄糖筛查以及采取有效的避孕措施至关重要。尽管一般建议近期患有妊娠期糖尿病的产后女性在产后早期进行产后检查，但数据显示这些女性的产后血糖检测率和高效避孕措施使用率并不理想。与产后早期相比，孕期女性与医疗保健提供者的接触更为频繁。这可能有助于改善孕妇与其医疗保健提供者之间的关系，从而增强女性对提供者咨询建议的信任。
本研究旨在调查在常规产后早期咨询的基础上增加产前咨询是否能提高患有妊娠期糖尿病的孕妇产后6周时的血糖筛查率和避孕措施使用率。
对280名被诊断为妊娠期糖尿病的女性进行了一项随机对照试验。参与者被随机分配（1:1，采用置换区组法分层）至干预组（在妊娠35 - 36周接受产前咨询加常规产后早期咨询）或对照组（仅接受常规产后早期咨询）。两个主要结局指标为产后6周时的血糖筛查和高效避孕措施的采用情况。次要结局指标为产后6周时任何避孕措施的使用情况。数据根据意向性分析原则进行分析。
干预组产后血糖筛查率为86.4%（121/140），显著高于对照组的50.7%（71/140）（调整相对风险，1.70；95%置信区间，1.27 - 2.28）。与对照组相比，干预组高效避孕方法的采用率有所提高（59.3%对30.7%；调整相对风险，1.90；95%置信区间，1.31 - 2.74）。干预组140名参与者中有122名（87.1%）报告在产后6周采用了任何避孕方法，对照组140名参与者中有77名（55.0%）采用了任何避孕方法（调整相对风险，1.58；95%置信区间，1.19 - 2.10）。
在常规产后早期咨询的基础上增加产前咨询显著提高了患有妊娠期糖尿病的孕妇产后6周时的血糖筛查率和避孕措施使用率。鉴于将产后血糖检测和有效避孕措施的咨询纳入标准产前护理只需极少的额外支出和人力，在临床实践中实施这种咨询策略似乎是可取的。
