Dr Naomi Whyler1,2, Dr Sushena Krishnaswamy1,3, Dr Sarah Price4,5, Prof Michelle Giles1,5,6
1Department of Obstetrics & Gynaecology, Monash University, Melbourne, Australia, 2Department of Obstetrics, Joan Kirner Women & Children's Hospital, Western Health, Melbourne, Australia, 3Monash Infectious Diseases, Monash Health, Melbourne, Australia, 4Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Melbourne, Australia, 5Department of Obstetric Medicine, Royal Women's Hospital, Parkville, Melbourne, Australia, 6Department of Infectious Diseases, University of Melbourne, Melbourne, Australia
Biography:
Dr Naomi Whyler is a General Medicine and Infectious Diseases specialist in Melbourne. She holds an appointment at Western Health as a Perinatal Infections consultant, and is undertaking a PhD through Monash University evaluating systems and strategies to enhance postpartum care for women diagnosed with medical complications in pregnancy.
Abstract:
Background: Gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy (HDP) are common, and are associated with long-term health implications[1]. Guidelines recommend postpartum testing after these conditions, but documented attendance rates are poor[1]. Evidence for optimal strategies to engage women in postpartum care is inconclusive[2]; administrative assistance has demonstrated promise in retrospective analysis[3].
Objective: We present an interim analysis from the POST-IT study; a postpartum intervention to increase attendance at recommended testing.
Methods: This randomised controlled trial compares postpartum testing uptake between control (standard of care) and intervention (administrative assistance with organising postpartum appointments and testing). A total of 144 women with GDM or HDP will be recruited to this study from Monash Health, Melbourne. Intervention will take place after 36 weeks, and participants are followed up at 4 months postpartum with telephone-based survey.
Baseline data: Since December 2023, 58 participants have been recruited with 6 follow-up surveys complete. Initial demographic data: average age 34 years, 30/58 (52%) born overseas, 31/58 (53%) primiparous, and 4/58 (7%) twin pregnancies. 38/58 (66%) have GDM, 14/58 (24%) have HDP; 6/58 (10%) have both. Control group has 27 participants (47%) and 31 (53%) are receiving intervention.
Preliminary results: Of 6 participants followed up at 4 months postpartum, 5 were in the intervention group. All attended their 6-week GP follow-up and discussed GDM/HDP diagnosis. None had undergone postpartum testing at four months, including one participant with two antenatal OGTT tests who did not want to have a third OGTT. Self-reported risk prediction for longer-term complications identified that participants felt they were at low risk (<10%) of progression to Type 2 diabetes or cardiovascular complications within 10 years postpartum.
Expected conclusion: This study will demonstrate whether administrative assistance improves attendance at postpartum testing, and will yield insights into behaviours and beliefs that drive attendance.
Keywords
postpartum testing, gestational diabetes, hypertension, pre-eclampsia
References
1. Jones EJ, Hernandez TL, Edmonds JK, Ferranti EP. Continued disparities in postpartum follow-up and screening among women with gestational diabetes and hypertensive disorders of pregnancy: a systematic review. J Perinat Neonatal Nurs. 2019; 33(2): 136-148.
2. Whyler N, Krishnaswamy S, Price S, Giles M. Strategies to improve postpartum engagement in healthcare after high-risk conditions diagnosed in pregnancy: a narrative review. Arch Gynecol Obstet. 2024. DOI: https://doi.org/10.1007/s00404-024-07562-7
3. Kabakian-Khasholian T, Campbell OMR. A simple way to increase service use: triggers of women's uptake of postpartum services. BJOG. 2005; 112(9): 1315-1321.