Gestational Diabetes Screening Intervention (American Samoa)
Gestational diabetes mellitus (GDM) is associated with significant morbidity for both pregnant women and their infants. Most significant for the mother are the associated risks of pregnancy hypertension and preeclampsia, cesarean delivery, and risk of development of Type II Diabetes postpartum. Risks to infants include excessively high birth weight (leading to delivery complications such as shoulder dystocia), preterm birth, respiratory distress syndrome, hypoglycemia, and risk of metabolic dysregulation in later life. Pacific Islanders are particularly susceptible to gestational diabetes. Multi-ethnic studies suggest that while the incidence of GDM in European populations is 2-6%, 9.9-14.8% of Pacific Islanders develop the condition.
This study is designed to understand pregnant women and health care providers knowledge about GDM and their attitudes toward GDM screening and then to address potential gaps in knowledge with a tailored health communications intervention. The first phase of this study, completed in August 2016, included questionnaire-based assessments and qualitative measures of both patient and provider knowledge. Using this information we are in the process of developing a video for use in the prenatal care clinics that will address some of the gaps in knowledge identified and summarized in this report as well as the known socio-cultural barriers contributing to low GDM screening rates. The video will be repeatedly presented at the prenatal care clinic at the Lyndon B Johnson Tropical Medical Center (LBJTMC) in May/June 2017. After women have had adequate time to be exposed to the content, we will repeat the knowledge and attitudes survey measures to determine whether our health communications intervention has a positive impact on knowledge and attitudes toward GDM. Using clinical record data we will also measure whether the video has had an impact on the uptake of GDM screening and consequent patient outcomes.
We argue that increasing pregnant women’s knowledge of GDM, and equipping them to advocate for their screening, follow up and treatment, will lead to significant improvements in the proportion of women successfully screening for GDM, and consequently significantly improve maternal morbidity (lower pregnancy hypertension, fewer cesarean sections) and infant outcomes (lower birthweight, less shoulder dystocia, less NICU admissions) because those with GDM will have been diagnosed and treated.
Timeline: This study will be actively recruiting participants between June and August 2017 at the Lyndon B Johnson Tropical Medical Center, American Samoa.
Investigators: Nicola Hawley, Bethel Muasau-Howard [Lyndon B Johnson Tropical Medical Center], Micah Van der Ryn [American Samoa Community College], Michaela Howells [University of North Carolina Wilmington]
Funding Source: Send Hope Not Flowers Foundation, Pacific Society for Reproductive Health, Yale Global Health Leadership Institute
Affiliated Students: Matau’itafa Faiai [MPH candidate, George Washington University]