Prevalence and factors associated with suicidality among adolescents with epilepsy attending national referral hospitals in Uganda.

Women with prior gestational diabetes mellitus (GDM) are at high risk for the development of type 2 diabetes (T2D) []. For instance, the literature shows that 20–50% of these women will develop T2D within ten years of a GDM diagnosis; 60% will be diagnosed with T2D sometime later in life [–]. Due to the consequences associated with T2D, both at a patient and health system level, there is a recent focus on efforts to prevent T2D after pregnancy among women with prior GDM. Randomized controlled trials (RCTs) indicate that diabetes prevention programs (DPPs) that provide personalized diet and physical activity support can reduce the risk of T2D after GDM between 24 and 43% [–]. However, translating interventions from the research setting to real-world implementation has challenges. Problems with uptake and engagement are particularly salient for programs involving newly postpartum women, which require an effective transition from prenatal to postpartum care at a time when competing demands of new motherhood reduce priority for self-care []. In addition to challenges related to the life stage of new motherhood that impact the ability to participate in a DPP, transitions from prenatal to postpartum care following a GDM pregnancy are often hampered by poor communication and integration between providers and organizations across care settings []. While prenatal care for GDM patients frequently involves intensive management by a specialized diabetes team, patients are generally discharged from diabetes care after delivery, often without a clear follow-up plan []. Even though women are made aware of their elevated risk of T2D and the ongoing need for future support, this care gap can leave them feeling abandoned by their healthcare team []. Currently, clinical guidelines recommend that women with GDM undergo postpartum T2D testing between six weeks and six months postpartum and receive counselling on T2D prevention []. In most cases, patients seek postpartum care from their primary care provider (PCP). While PCPs consider T2D prevention and testing their responsibility, many report being unaware that their patient had GDM [], underscoring the need for better integration between prenatal specialty care and postpartum primary care. Evidence also indicates that postpartum T2D testing rates remain low among this population [–], even with frequent PCP visits [], suggesting that women see their PCP for reasons other than T2D prevention and testing.