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The number of women diagnosed with diabetes, including gestational diabetes, will continue to increase in the face of epidemic rates of obesity. The concurrent rise in obesity and diabetes makes it important to determine the risk factors for gestational diabetes mellitus (GDM) and the nature and extent of care offered to this population by physicians. This is a two part study. Part I explores risk factors for GDM in a state-wide sample of women who completed the Pregnancy Risk Assessment
Monitoring System (PRAMS) questionnaire in 2001. PRAMS participants were randomly drawn from Oregon birth certificates. In 2001, 1783 women completed PRAMS and responded to the question regarding gestational diabetes on the birth
certificate with a yes or no answer. Results indicated that approximately 4% of
Oregon pregnancies are complicated by GDM, with Asian/Pacific Islander and
Hispanics having the greatest incidence of GDM. Logistic regression analysis
determined that significant predictors for GDM were pre-pregnancy body mass
index>25 kg/m2, racial/ethnic minority group membership, and maternal age>25
years.
Part II of this study explored the nature and extent of care offered by physicians during pregnancy and in the postpartum period using a mailed survey designed for this research. Two hundred and eighty three physicians in obstetrics and gynecology and
family practice completed a survey assessing physician care patterns, beliefs, opinions and attitudes regarding GDM care. Results indicated that over 95% of Oregon
physicians were testing for GDM during gestation. In the postpartum period very few
physicians were testing for glucose intolerance. Only 19% of the same physicians that always tested for GDM are testing blood glucose levels in the postpartum period. Results of logistic regression that assessed variables associated with level of postpartum care indicated that female physicians were more likely to offer more comprehensive postpartum care as compared to male physicians. Logistic regression
also indicated that subjective norms were associated with physician’s likelihood of
screening women for glucose intolerance in the postpartum period. The findings from
this study will assist health care professionals in identifying women at greatest risk for GDM and identifies established care guidelines need to be brought into clinical practice. |
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