Summary of “Health Behaviours of Postpartum Women with a History of Gestational Diabetes”

A population-based study of Canadian women with a history of gestational diabetes mellitus conducted by Marilyn K. Evans, Linda J. Patrick, and Christine M. Wellington and published in the Canadian Journal of Diabetes showed a rapid increase in development of diabetes in the first year postpartum (3.7%), with almost 20% of women developing type 2 diabetes by 9 years postpartum (Evans et al., 2010). Weight management, diet, and physical activity are recommended during pregnancy, but postpartum care is lacking. Motherhood can result in fatigue, postpartum depression, or a change in health, making it difficult for patients to attend to personal care issues.

Evans,et al. used a concurrent mixed method, qualitatively driven design with semi-structured interviews (topics included: health, role, function, family life, daily living activities, work, and health), Short-Form 36 (SF-36) Health Survey, and diet/activity-level diaries collected at multiple interviews for assessment. Participating patients rated their health as good or very good, but diets were lacking in nutrition. Women felt “abandonment and uncertainty” concerning postpartum health, and continuing health education/support was needed (Evans et al. 2010, p. 227). Assessment of the following would be recommended by an NP: patient weight, blood glucose levels, diet, physical activity levels, mental health, and patient level of willingness to improve health with support.

The feelings and the pressures of motherhood caused depression, fatigue, and a lack of healthy diet and exercise. Four main issues were noted by Evans et al.: abandonment, uncertainty, inability to remain healthy, and moving on from a gestational diabetes diagnosis. Support was dramatically reduced postpartum when it was still needed by patients. The diagnosis for these patients is a knowledge deficit resulting in inability to manage their health without outside support from knowledgeable healthcare counselors.

Follow-up care and counseling on healthy lifestyle maintenance including diet, exercise, and support were recommended in the article to treat the symptoms of abandonment, uncertainty, and generally unacceptable health that lead to type 2 diabetes mellitus. Education on blood glucose testing was also encouraged by Evans et al. (2010), so that women could closely monitor their own risk for type 2 diabetes. Planning for frequency and length of patient education and follow-up care is required here, from a nursing standpoint. Depression and fatigue should be addressed before the less urgent concerns of insufficient diet and exercise.

Evans, et al. indicate that implementation of follow-up care and patient education (including but not limited to diet, exercise, help options, and outcomes of patient actions) will result in a lower rate of type 2 diabetes mellitus in patients in the study. According to the article, measurable goals for patients might include: continued monitoring of patient health, education, counseling support, and referrals for additional care required. A more specific plan will be needed for each patient, concurrent to daily, weekly, and monthly schedules, and implemented through outpatient counseling centers, phone and email communication, and regular visits to a general practitioner to measure patient health. Group education classes at local hospitals would be ideal.

Evans,et al. concludes that postpartum follow-up is needed for delaying or preventing development of type 2 diabetes in the women in this study. Patients need supportive counseling on how to maximize weight loss and eat a healthy diet. Long-term follow-up and interventions are excellent strategies for the prevention of type 2 diabetes. In an evaluation of a postpartum patient who contracted diabetes mellitus during pregnancy, an evaluation would include the condition (improved, stabilized, or deteriorated, died, or discharged) of the patient after educational intervention and diet and exercise counseling.

Reference

Evans, M. K., Patrick, L. J., & Wellington, C. M. (2010). Health behaviours of postpartum women with a history of gestational diabetes. Canadian Journal of Diabetes, 34(3), 227-232. doi: 10.1038/nm.3106.doi:10.1016/S1499-2671(10)43011-7.