- Title
- An investigation into the dietary management of gestational diabetes in Australian women and postnatal health and lifestyle behaviours for future diabetes risk reduction
- Creator
- Morrison, Melinda Kristy
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2013
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Gestational diabetes mellitus (GDM) is a form of diabetes with onset or first recognition during pregnancy. GDM has been associated with an increased risk of adverse pregnancy outcomes and longer term health consequences for both mother and offspring, including an increased risk of type 2 diabetes. With evidence suggesting rates of GDM are increasing in Australia, there is a need to optimise dietary interventions and strategies for future diabetes risk reduction, in order to ensure the best possible pregnancy outcomes and address the growing public health problem of type 2 diabetes. The primary purpose of this thesis is to investigate current Australian dietetic practice in the management of GDM; describe the postnatal health and lifestyle patterns of women with recent GDM and identify factors that influence preventive health behaviours for future type 2 diabetes risk reduction. Three research studies were undertaken to meet the aims of this body of research. A survey of Australian dietitians (n=220) currently working in GDM management was undertaken to examine Australian dietetic practice in the management of GDM, identify current models of dietetic care and determine the need for national evidence based GDM guidelines. The study showed consistency in key components of nutrition education; however there were a number of differences in the implementation of medical nutrition therapy by Australian dietitians in regards to nutrient recommendations. Overall, the survey results strongly indicate a need for evidence-based gestational diabetes practice guidelines and nutritional recommendations and provided baseline data for future practice of Australian dietitians working in GDM. Postnatal health and lifestyle behaviours in women with GDM were investigated in a cross sectional survey of women with diagnosed with GDM in the previous three years and registered with the National Diabetes Services Scheme (NDSS) (n=1372). This study highlighted low rates (27.4%) of return for follow-up diabetes screening compared to current recommendations, and found that receiving specialised diabetes care, risk reduction advice and postnatal reminders were associated with an increased likelihood of returning for follow-up. Women with recent GDM also failed to achieve diet patterns in line with current national dietary recommendations, as evidenced by overall poor diet quality measured using the Australian Recommended Food Score (mean ±SD ARFS 30.9±8.1). Although women with known risk factors for type 2 diabetes were more likely to perceive that they were high risk for diabetes up to three years after a GDM pregnancy, one third still considered themselves to be at low or very low risk for the development of diabetes. In qualitative analysis of women’s experiences of living with GDM in this study, the importance of health professional support was highlighted and some of the challenges and opportunities for future diabetes risk reduction identified. Breastfeeding was examined as part of a mixed methods study within this body of work. In the quantitative component of this research a cross-sectional online survey was undertaken with women (n=729) diagnosed with GDM in 2010 and registered with the NDSS. Early breastfeeding cessation was found to be associated with breastfeeding problems at home, return to work prior to three months, not being married or in a de facto relationship, inadequate breastfeeding support, caesarean delivery, living in a lower socioeconomic area and having a higher BMI. This study identified those at highest risk of early breastfeeding cessation and suggests that additional breastfeeding support specifically targeting women with GDM is needed. In conclusion, the study findings presented in this thesis highlight the need for an evidence based approach to dietetic interventions provided to women with GDM and improved access to postnatal care. The findings also demonstrated that the current postnatal health and lifestyle behaviours of Australian women with GDM are not conducive to chronic disease prevention. This research demonstrates the need for strategies to promote and support preventive health behaviours in Australian women with GDM in order to reduce risk factors for type 2 diabetes and optimise maternal health and well-being.
- Subject
- gestational diabetes; diabetes prevention; pregnancy; lifestyle patterns; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1042423
- Identifier
- uon:14054
- Rights
- Copyright 2013 Melinda Kristy Morrison
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Abstract | 452 KB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Thesis | 3 MB | Adobe Acrobat PDF | View Details Download |