SOMANZ Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2025

Heart of the matter: what do women who experience medical conditions in pregnancy want from their postpartum care? (#191)

Naomi CA Whyler 1 2 , Sushena Krishnaswamy 1 3 , Sarah Price 4 5 , Michelle L Giles 1 5 6
  1. Department of Obstetrics, Monash University, Melbourne, Victoria, Australia
  2. Western Health, Sunshine, VICTORIA, Australia
  3. Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
  4. Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
  5. Department of Obstetric Medicine, Royal Women's Hospital, Melbourne, Victoria, A
  6. Department of Infectious Diseases, University of Melbourne, Melbourne, Victoria, A

Background

Gestational diabetes (GDM) and hypertensive disorders including pre-eclampsia (HDP) are common obstetric conditions with long-term maternal cardiometabolic risks1,2. Postpartum care including testing is recommended after GDM/HDP3,4; however, uptake is suboptimal3.

Aims

To explore intentions to seek care and have recommended tests, and the barriers and facilitators contributing to uptake of postpartum care after GDM and/or HDP through the first year after delivery.

Methods

We used a mixed-methods approach including anonymous online surveys analysing intentions to seek care; semi-structured questionnaires within a randomised controlled trial providing support in organising postpartum care; and qualitative interviews analysing early intentions to seek care.


Results

Interim analysis includes 79 surveys (39 GDM, 40 HDP), 56 semi-structured questionnaires, and six qualitative interviews. Awareness of recommended testing was high in GDM (29/35, 83%) but not HDP (6/35, 17%); most women intended to undergo testing (HDP 26/36, 72%; GDM 26/35, 74%). Estimates of cardiometabolic risk at 10 years were higher in GDM (40% risk) than HDP (27% estimated risk). Thematic analysis identified that intentions to access care were challenged by barriers including lack of time, uncertainty about recommended care, competing priorities, fragmented care pathways between hospital and community, and lack of understanding of long-term risks.

Conclusion:

Intentions to seek postpartum care are high but women experience multiple barriers, including uncertainty about what, how, where and when to access care. Focused education and individualised care may empower women with their postpartum health, and should be implemented alongside systemic strategies which reduce barriers to accessing care.

  1. Clark HD, Keely E. (2012) Getting mothers with gestational diabetes to return for postpartum testing: what works and what does not. Diabetes Manage 2(1):33-39.
  2. Davis GK, Henry A, Arnott C, Brown MA. (2021) The long-term cardiovascular impact of hypertension in pregnancy – a missed opportunity. Aust N Z J Obstet Gynaecol 61(3):474-477
  3. Whyler NCA, Krishnaswamy S, Price S, Giles ML. (2024) Strategies to improve postpartum engagement in healthcare after high-risk conditions diagnosed in pregnancy: a narrative review. Arch Gynecol Obstet; 310(1):69-82.
  4. Society of Obstetric Medicine Australia and New Zealand, Hypertension in Pregnancy Guideline, Sydney, 2023.