Associate Professor Zoe Bradfield is speaking at our symposium for healthcare professionals on August 18, which poses the question – GDM screening– are we doing it right? She talks to ZOE DELEUIL about her research.
Gestational diabetes mellitus (GDM) affects one in six pregnancies in Australia, with cases tripling over the past decade. Increasingly, however, pregnant women are opting out of GDM screening via the Oral Glucose Tolerance Test (OGTT).
Dr Zoe Bradfield is head of the SWEET Mum + Baby Study, national research comparing outcomes for babies born to mothers with GDM, those who tested negative and those who declined screening over the past five years in WA’s largest maternity service. A multidisciplinary team has collected 1700 online responses nationally to their survey and examined the data of 30,000 mother baby dyads to learn more about gestational diabetes.
Currently, Bradfield says, there is no data on how many women decline the test, and the impact this may have on their pregnancy and their experience of motherhood.
“In the online responses it became clear that women who chose to decline the GDM test really wanted their story told,” she says. “We need to understand more about women’s experience of gestational diabetes and the burden of current testing. The whole story of diagnosis with GDM, and of living with GDM, is what I’m interested in.”
The oral glucose tolerance test (OGTT) for gestational diabetes requires women to fast overnight, then attend a laboratory for a series of blood tests. After an initial blood test, they have a drink containing 75g of glucose, wait two hours, and have their blood tested again at one- and two-hour marks. Women need to wait in the laboratory for two hours while this testing is being undertaken.
For women with work and family commitments, or those experiencing health challenges, this testing process can be a significant additional burden. Women who are diagnosed with GDM are advised to take the test again in the often-challenging weeks after the baby is born. While the OGTT is recommended, women have the right to decline it.
Bradfield says that supporting women’s informed decision-making around the test is key.
“Women want to know what happens if the test is positive. How does that affect their clinical care and birthing options? How do they connect to health professionals?”
Another critical issue the study highlights is the lack of follow-up for women diagnosed with GDM, who are more likely to develop type 2 diabetes later on.
“We recruited post-partum women for the study, because there is so little data on how many women do the post-partum oral glucose tolerance test,” says Bradfield. “If we have a tsunami of type 2 diabetes coming our way, we need to know much more about the impact of a GDM diagnosis on the post-partum period.”
She acknowledges that there are many reasons women choose to decline the test, and a range of factors that health professionals can’t influence, but says there is an urgent need listen to women at a national level, and the time is now.
“By identifying risk factors and advocating for more effective screening methods, this research will contribute to enhanced healthcare policies, clinical guidelines, and public awareness campaigns about the importance of prevention and management of GDM,” she says.
She sees this symposium as an opportunity for health professionals to hear about the latest innovations around testing, such as home tests, and talk more about where we should be focussing our attention for the future of GDM care.
“Right now, women are groaning under the burden of the current mechanism for testing. And they are feeling lost, scared and afraid when they have GDM and are connecting with healthcare. The collective narrative is so compelling that we can’t ignore it. You can’t be too starry eyed about this, and you can’t fix everything, but we can and must do better than we are. Otherwise, women are going to continue not to test.”
Dr Zoe Bradfield is an Associate Professor of Midwifery with a joint appointment between Curtin University and the Women and Newborn Health Service in Western Australia. Zoe also holds an adjunct at the School of Medicine at the University of Western Australia and has an Honorary Appointment at the Burnet Institute in Victoria. Zoe is an NHMRC Early Leadership Fellow and is the President of the Australian College of Midwives.
Are you a health professional wanting to learn more about gestational diabetes screening?
Find out more about our upcoming symposium for health professionals here.
