None listed
Conditions
Brief summary
Women who have a diagnosis of gestational diabetes or hypertension in pregnancy are recommended to have further testing postpartum to review their longer term health risks; however, many women do not undergo testing in a timely manner due to many competing priorities. This study is evaluating whether an intervention providing administrative assistance can improve attendance and testing in the post partum period. Participants in the POST-IT study are randomly allocated to receive standard of care (usual advice with no administrative assistance) or intervention (assistance to book GP visit and recommended testing after GDM or HDP). Attendance rates, uptake of testing, and acceptability of the intervention will be evaluated at four months' postpartum via telephone survey.
Interventions
The intervention consists of personalised administrative assistance to attend the recommended postpartum 6-week GP review and undergo recommended postpartum testing after gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP) in keeping with current recommendations. This will include: 1. Booking the appointment with the participant's GP at a day and time of their choosing 2. Provision of pathology forms for oral glucose tolerance test (OGTT) (if GDM); and for 24 hour blood pressure monitor, urinary protein:creatinine ratio and blood tests for fasting lipids and glucose (if HDP). 4. Booking of OGTT (if GDM) at pathology centre of participant's choice at 12 weeks postpartum. The participant will be provided with a single page summary of the appointments. The personalised administrative assistance is provided by the PhD student investigator on the study team. This is provided either at or after 36 weeks for those recruited antenatally, and within one week postpartum for those recruited postpartum. Fidelity to the intervention will be assessed primarily at the four month survey for all participants. A subset will also undergo validation by correspondence with the participant's GP, for those who provide consent to do so during the participant recruitment and consent process. Validation involves the following: no active participation from participants. Contact with consenting participants' primary care practitioner will be performed for this subset, and data on a. whether a six week visit was performed; b. whether an OGTT or other diabetes screening test has been performed postpartum, and when (for those with GDM); and c. whether additional testing after hypertensive disorder in pregnancy has been performed, and which tests these are. The timing of this subset validation will be: six months postpartum, i.e. two months following the participant's four month survey.
Sponsors
Study design
Eligibility
Inclusion criteria
Planning to receive all antenatal care at site of study recruitment Diagnosed with HDP or GDM at any point during pregnancy
Exclusion criteria
Aged <18 years Past history of hypertension, Type 1 or Type 2 diabetes or Mature Onset Diabetes of the Young (MODY) that predates current pregnancy and for which they receive long term healthcare follow up Diagnosis of severe GDM or HDP with activation of alternative specialist postpartum pathways: endocrinologist (GDM with complex management needs or concern for pre-existing Type 1 diabetes or MODY); or nephrologist (severe pre-eclampsia, eclampsia, or Haemolysis/Elevated Liver enzymes/Low platelets HELLP syndrome). Residence interstate/overseas and planning to complete postpartum care outside of Victoria. Women who have had a fetal death in utero or stillbirth; if already recruited, then they will automatically be withdrawn from the study. Women who have complex medical or psychiatric needs in the peripartum period requiring extended stay (> two weeks, or > one week in Intensive Care Unit) postpartum; or otherwise deemed unsuitable at the discretion of the researcher/clinician. Women who are incarcerated, who do not speak English and there is no interpreter available to obtain consent Women who give birth prior to 32 weeks where an alternate postpartum pathway is in situ for follow-up