Background: Gestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before. Objective: This study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting. Methods: This mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore. Results: The patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers. Conclusions: A GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women.

IN BRIEF Gestational diabetes mellitus (GDM) increases the risk for type 2 diabetes. This qualitative study aimed to evaluate health care providers’ perceptions of care responsibilities and resources related to reducing type 2 diabetes risk among women with previous GDM in Singapore. Health care providers acknowledged a shared responsibility. They felt that they had less understanding of compliance with long-term maintenance of lifestyle change, exacerbated further by fragmentation of follow-up care. The application of more integrated patient-centered care models, combined with greater health literacy, is urgently required in this area.

(1) Background: Breastfeeding has been shown to support glucose homeostasis in women after a pregnancy complicated by gestational diabetes mellitus (GDM) and is potentially effective at reducing long-term diabetes risk. (2) Methods: Data from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study were analyzed to understand the influence of breastfeeding duration on long-term dysglycemia (prediabetes and diabetes) risk in women who had GDM in the index pregnancy. GDM and dysglycemia four to seven years postpartum were determined by the oral glucose tolerance test (OGTT). A Poisson regression model with a robust error variance was used to estimate incidence rate ratios (IRRs) for dysglycemia four to seven years post-delivery according to groupings of the duration of any breastfeeding (<1, ≥1 to <6, and ≥6 months). (3) Results: Women who had GDM during the index pregnancy and complete breastfeeding information and OGTT four to seven years postpartum were included in this study (n = 116). Fifty-one women (44%) had postpartum dysglycemia. Unadjusted IRRs showed an inverse association between dysglycemia risk and ≥1 month to <6 months (IRR 0.91; 95% confidence interval [CI] 0.57, 1.43; p = 0.68) and ≥6 months (IRR 0.50; 95% CI 0.27, 0.91; p = 0.02) breastfeeding compared to <1 month of any breastfeeding. After adjusting for key confounders, the IRR for the ≥6 months group remained significant (IRR 0.42; 95% CI 0.22, 0.80; p = 0.008). (4) Conclusions: Our results suggest that any breastfeeding of six months or longer may reduce long-term dysglycemia risk in women with a history of GDM in an Asian setting. Breastfeeding has benefits for mothers beyond weight loss, particularly for those with GDM.

Aim: To assess and explore the factors affecting willingness to undergo an early postpartum oral glucose tolerance test (OGTT) and receive postpartum lifestyle modification assistance. Methods: An explanatory sequential mixed-method design was used. A prenatal cross-sectional survey questionnaire (n = 216) was given to women diagnosed with GDM in a tertiary health institution in Singapore and followed up with postpartum semi-structured interviews (n = 30). Multivariate logistic regression and thematic analysis were conducted before merging the findings. Results: Despite universal GDM education, fewer than 75% intended to take the OGTT postpartum, and only 63% felt it was very important. The plan to take the OGTT postpartum was positively associated with a prenatal care provider’s specific recommendation. In contrast, Malay women were less likely to take the test. Most women interpreted a care provider’s recommendation as implying standard practice, which encouraged intended and actual compliance with testing after giving birth. The perception of moderate to high T2DM risk in the following decade, and subsidized prenatal care, and plan to take the OGTT postpartum were positively associated with willingness to receive postpartum lifestyle behavior support. A mobile application was the preferred method to receive support. Conclusions: In the early postpartum period, women with a history of GDM were willing to receive measures to reduce T2DM risk, primarily if it was under the supervision and recommendation of a care provider. A carefully designed but simple postpartum lifestyle intervention incorporating these preferences that can be integrated into mainstream diabetes prevention programs is warranted.

Human papillomavirus (HPV) is the main causative agent of cervical cancer. This cross-sectional survey examined differences in HPV status and risky sexual behaviors between food-secure and food-insecure adult females living in rural Appalachia (n = 153). Most had HPV-negative test results [n = 139 (91.4%)]. Overall, 49 participants (35.5%) had low Risky Sexual Behavior scores, while 28 (20.3%) and 61 (44.2%), respectively, had medium- and high-risk levels. Non-fully food-secure participants had significantly higher scores, compared to their fully food-secure counterparts (p < 0.001). Women living in food-insecure households may be at risk for riskier sexual behaviors, which may contribute to the higher cervical cancer rates in Appalachia.