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Table 4 Barriers identified in high-income and low- and middle-income countries

From: From screening to postpartum follow-up – the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review

High-income countries Low- and middle-income countries
• No studies focusing on barriers to GDM screening and diagnosis were identified. • Barriers to GDM screening and diagnosis include difficulties in screening women during the recommended time period, applicability and relevance of the risk factors used in selective screening programmes, challenges in testing women in the fasting state and need for repeat test, screening procedure being too time consuming, scarcity of test consumables and lack of equipment.
• Barriers to treatment include lack of social support, stress, cost of healthy food, cost of health care and medical supplies, lack of advice and information about diet and exercise, dietary messages being contradictory, dietary messages being difficult to understand, lack of trust in messages received from the health care providers, waiting time to access health care providers for advice, lack of access to health care and health insurance, pregnancy-related food preferences and cravings, diet plans being perceived as stressful, adaptation of unhealthy eating patterns such as bulimia and binging, frequent use of ‘comfort foods’, difficulty in adhering to a diet when participating in social gatherings, concerns for baby’s growth and putting a strain on the baby, reluctance to inject insulin, treatment being time consuming, lack of knowledge, denial of severity, lack of motivation, other social barriers. • Barriers to treatment include confusion over dietary recommendations, lack of sufficient advice, concerns about the effects of the recommendations, structural changes such as more cars leading to reduced physical activity, more unhealthy take away food options and lower rates of home cooking and eating of traditional foods.
• Barriers to postpartum screening include health care provider not seeing the patient, the patient being lost to follow-up, lack of communication/collaboration between health care providers, inconsistent guidelines or lack of familiarity to guidelines, not aware about history of GDM, patients not considering the test necessary, or declining testing, or unable to complete test, testing not affordable, patient uninformed or lack understanding of need for test, practice being too busy, time pressure (women), lost requisition, recent delivery experience, baby’s health issues, adjustment to the new baby (emotional stress, feeling overwhelmed and lack of time and burden of child care), concerns about postpartum and future health (feeling healthy and not in need for care, and fear of receiving bad news), and experiences with medical care and services (dissatisfaction with care and logistics of accessing care). • No studies focusing on barriers to postpartum GDM screening were identified
• Barriers to healthy postpartum lifestyle include lack of time and/or energy, lack of child care support, not feeling well, emotional distress, lack of motivation, financial barriers, domestic responsibilities such as cooking, lack of knowledge, lack of understanding about GDM, lack of social support, lack of support from health care provider, feeling of solitude, dullness and isolation from family and friends, poor body image, bad weather, considering oneself to be too young to be on a restricted diet, obstacles at work, unsuitable local neighbourhood, no access to exercise equipment, cultural expectations, lack of enjoyment of physical activity, breastfeeding as it made some women increase their food intake. No studies focusing on barriers to healthy postpartum lifestyle were identified