{"id":{"repo_id":"cambridge","oai_identifier":"oai:www.repository.cam.ac.uk:1810/318560"},"canonical_url":"https://search.dev.ndltd.org/etd/cambridge/oai:www.repository.cam.ac.uk:1810/318560","repository":{"repo_id":"cambridge","name":"Cambridge University","base_url":"https://api.repository.cam.ac.uk/server/oai/request"},"display":{"title":"Primary care management of risk of type 2 diabetes in women with a history of gestational diabetes","abstract":"This thesis aims to inform strategies to improve care for mothers after a pregnancy affected by gestational diabetes (GD) in relation to risk of type 2 diabetes (T2D) after delivery. Through a systematic review (including 129 studies of 310,214 women with GD, Study 1) and study-level meta-regression, I highlighted that a third of women developed T2D within 15 years of GD a pregnancy. Progression was higher in non-White European populations compared to other populations, and in those with higher BMI at follow-up. These findings emphasised the need for both sustained follow-up after GD through screening, and interventions to reduce modifiable risk factors. Currently, screening for T2D is recommended at six to 13 weeks after a GD pregnancy, then subsequently at regular intervals. Consistent with other studies, I identified that 25.4% patients (n=556) did not undergo a postpartum test at a local hospital between 2014 and 2017 (Study 2). It is also known that many mothers find it challenging to maintain a healthy lifestyle after a GD pregnancy, and do not make changes to their diet or activity levels to reduce their risk. To explore reasons for this, I conducted two qualitative systematic reviews and developed 30 recommendations to promote screening attendance, healthy diet and physical activity based on the findings (Studies 3 and 4). I then elicited an evaluation of these recommendations from 20 mothers with previous GD (Study 5), in addition to their own ideas for improving postpartum support. Lifestyle advice amid a busy schedule and tips for sustaining changes, along with flexibility in screening appointments and invitations, were welcomed. I have highlighted that women with GD are an easily-identifiable group at high risk of T2D, and there is a need for interventions to manage this risk. I have provided evidence to support and inform such interventions during pregnancy and postpartum, which could include feasible adaptation to current practice, to improve care.","abstract_html":"This thesis aims to inform strategies to improve care for mothers after a pregnancy affected by gestational diabetes (GD) in relation to risk of type 2 diabetes (T2D) after delivery. Through a systematic review (including 129 studies of 310,214 women with GD, Study 1) and study-level meta-regression, I highlighted that a third of women developed T2D within 15 years of GD a pregnancy. Progression was higher in non-White European populations compared to other populations, and in those with higher BMI at follow-up. These findings emphasised the need for both sustained follow-up after GD through screening, and interventions to reduce modifiable risk factors. Currently, screening for T2D is recommended at six to 13 weeks after a GD pregnancy, then subsequently at regular intervals. Consistent with other studies, I identified that 25.4% patients (n=556) did not undergo a postpartum test at a local hospital between 2014 and 2017 (Study 2). It is also known that many mothers find it challenging to maintain a healthy lifestyle after a GD pregnancy, and do not make changes to their diet or activity levels to reduce their risk. To explore reasons for this, I conducted two qualitative systematic reviews and developed 30 recommendations to promote screening attendance, healthy diet and physical activity based on the findings (Studies 3 and 4). I then elicited an evaluation of these recommendations from 20 mothers with previous GD (Study 5), in addition to their own ideas for improving postpartum support. Lifestyle advice amid a busy schedule and tips for sustaining changes, along with flexibility in screening appointments and invitations, were welcomed. I have highlighted that women with GD are an easily-identifiable group at high risk of T2D, and there is a need for interventions to manage this risk. I have provided evidence to support and inform such interventions during pregnancy and postpartum, which could include feasible adaptation to current practice, to improve care.","abstract_has_math":false,"creators":["Dennison, Rebecca"],"institution":"University of Cambridge","degree_name":"Doctor of Philosophy (PhD)","degree_level":"Doctoral","degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":["Griffin, Simon","Usher-Smith, Juliet"],"committee_chairs":[],"committee_members":[],"year":2020,"date_issued":"2020-09-01","date_published":"2020-09-01","updated_at":"2026-07-22T22:24:16Z","subjects":["Primary care","Gestational diabetes","Type 2 diabetes","Prevention"],"languages":["eng"],"rights":[],"rights_urls":["https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/9023b38f-5386-426a-b863-f4bd1002dda6/download","https://www.rioxx.net/licenses/all-rights-reserved/"],"identifier_entries":[{"key":"dc:creator.authoridentifier","label":"Author Identifier","values":["0000000221574797","0000000285012531"],"render_values":[{"text":"0000-0002-2157-4797","href":"https://orcid.org/0000-0002-2157-4797","code":true},{"text":"0000-0002-8501-2531","href":"https://orcid.org/0000-0002-8501-2531","code":true}]}]},"links":{"outbound_url":"https://doi.org/10.17863/CAM.65673","outbound_label":"DOI","outbound_source":"dc:identifier.doi"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor.advisor","label":"Advisor","values":["Griffin, Simon","Usher-Smith, Juliet"]},{"key":"dc:contributor.sponsor","label":"Sponsor","values":["This project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR; SPCR-S-S102). 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