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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]

Relevant Publications:

If you can not access any of the full publications, please reach out to Nicola Hawley

1. Knowledge of Gestational Diabetes Mellitus among pregnant women in American Samoa.

Hawley, N., Tripathi, R., Muasau-Howard, B., Howells, M., Faiai, M., & Van der Ryn, M. (2019). Pacific Journal Reproductive Health, 1(8), 410-422. doi:10.18313/pjrh.2019.902

The aim of this study was to examine the knowledge of Gestational Diabetes Mellitus, or GDM, among pregnant women in America. Using an 86-item survey completed by women attending a prenatal care clinic during a cross-sectional study, we tabulated and normalized scores for five domains including: general knowledge, risk factors, maternal complications, infant complications, and testing and treatment. We found the mean total knowledge scores were low—25.8 out of 100—and mean scores were highest for the testing and treatment domain and lowest for the knowledge of risk factors domain. The findings show a lack of GDM knowledge reported by pregnant woman in American Samoa and suggest a critical need to develop effective and wide-reaching health communications interventions to address knowledge deficits and potentially improve utilisation of GDM screening.

2. An evaluation of gestational diabetes mellitus screening practices in American Samoa.

Freeman, J., Thompson, K., Muasau-Howard, B., McGarvey, S.T. & Hawley, N.L. (2015) Pacific Journal of Reproductive Health 1 (2): 68-73

The study evaluated the adequacy of gestational diabetes screening among pregnant women in American Samoa through the review of 622 clinical records to determine: whether or not the patient was screened, the week of gestation in which the screening occurred, and the type of screening the patient received. According to the findings, only 16.2% of women received adequate gestational diabetes screening. This study highlights the critical need for improved screening in this high risk population and urges that the causes of inadequate screening be identified and that interventions be targeted at both patients and clinicians.

GDM Video

After a first phase of assessments to develop knowledge of GDM in prenatal care clinics in American Samoa, the information was used to develop a video addressing gaps in knowledge and social-cultural barriers in the Samoan context.