Background/Purpose: Gestational diabetes mellitus (GDM) increases a woman’s risk of developing type 2 diabetes (T2DM) 8-10-fold. (1) A T2DM diagnosis can occur within a 3–6-year period following pregnancy. (1) At Western Health (WH) the GDM diagnosis rate is high, with one in four pregnancies being affected. Half of these women will be prescribed insulin therapy, further increasing their risk for T2DM. (1) The annual birthrate (n=6500) is expected to increase to >7000 by 2026, which may result in a further rise in GDM patients.
Recent best practice advice (1) suggests health behaviour modifications (weight reduction, improved diet quality, and adequate physical activity) can reduce the risk of developing T2DM following a GDM pregnancy. (1) Therefore, the WH dietetic team aimed to implement a postpartum prevention service targeting health behaviours, for women with a history of insulin-requiring GDM.
Approach: With support from the Victorian Better at Home Funding initiative, WH implemented a dietitian-led telehealth prevention service in June 2023. All women who experienced an insulin-requiring GDM pregnancy were offered the service. Antenatal dietitians contacted eligible women from ~10 weeks postpartum, and each received 4-5 individualised consultations spanning 12 months. The service comprised one-on-one phone and/or video consultations providing support, evidence-based strategies to facilitate health behaviour change, and targeted resources. The same dietitian provided nutritional support throughout a woman’s GDM journey at WH to ensure continuity of care.
Outcomes: Preliminary data analysis suggests more than a third of women (n=123, 39%) were aged between 31-35 years and of Indian descent (n=105, 33%). Of the eligible women (n=316), 99% accepted a referral to the service. More than 83% (n=300) attended the initial consultation, with over 800 appointments conducted since service commencement. To date, 8% (n=27) have completed the full service (4-5 consultations), with >200 still actively completing the service. Of the women, 32% (n=100) were living with overweight (BMI 25-29kg/m2) and 41% (n=128) were living with obesity (BMI >30kg/m2). Uptake of the postpartum OGTT was >80% at 6 months post-birth. Increased fruit and wholegrain intake and decreased consumption of discretionary foods and sweetened beverages were observed.
Significance: Overall, a high level of service engagement, OGTT uptake, and health behaviour changes were observed. An insulin-requiring GDM pregnancy and increased risk of T2DM can significantly impact women's health outcomes. Therefore, the WH dietitian-led prevention telehealth service is critical in providing women with evidence-based support to facilitate early intervention and mitigate the risk of T2DM.