الفهرس 
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Abstract
GDM (gestational diabetes mellitus) was once described as glucose intolerance that started or was discovered during pregnancy. Even though most women with GDM improve their glucose tolerance after delivery, those who have had GDM before are more likely to have impaired glucose tolerance and type 2 diabetes (DM). T2DM is projected to be prevalent in 50-70 percent of women 5-10 years following delivery (American Diabetes Association, 2014).
Postpartum screening is recommended by some professional organizations and organizations around the world for women who have had a history of GDM. Fasting blood glucose levels or the 75-gram oral glucose tolerance test are recommended by the American Diabetes Association (ADA) for measuring glucose levels within 6 to 12 weeks following delivery (OGTT). Women should be examined every three years if their test results are normal; however, if they have impaired glucose tolerance or fasting blood glucose, they should be evaluated annually. Furthermore, the World Health Organization (WHO) recommends type 2 diabetes (T2DM) postpartum screening 6 weeks or longer after delivery, but not after that (WHO, 2013).
Despite the need for postpartum screening and broad demands for screening individuals with past gestational diabetes, there are numerous hurdles to compliance. Patient-related issues such as exhaustion, maternal connections, and parental commitments, for example, are key roadblocks in the early postpartum period. Work, family, and children’s development have all become increasing impediments over time (Cho et al., 2015).
Obstetric nurses have a critical role in women’s health and the prevention of many postpartum ailments, hence they should be more included in postpartum care programs. To increase compliance with postpartum blood glucose testing, obstetric nurses should follow the expected recommendations, which should begin during pregnancy, and be prepared to handle the transition to a parent’s postpartum care plan, according to ACOG’s recommendations. In addition, within the first three weeks after delivery, all mothers should get obstetric care (ACOG, 2018).
Aim of the study:
This study aimed to assess barriers affecting compliance of women with a history of gestational diabetes to post-partum glucose screening through:
Assessment of women’s knowledge concerning post-partum glucose screening.
Assessment of barriers affecting women’s compliance with post-partum glucose screening.
Research questions:
Are the women having correct knowledge regarding postpartum glucose screening?
What are the barriers affecting women’s compliance with a history of gestational diabetes to post-partum glucose screening?
What are women’s reasons for compliance and non-compliance with post-partum glucose screening?
Methodology:
Research design
A descriptive study design was utilized.
Setting
¬The study was conducted at postnatal unit at Ain Shams Maternity Hospital.
Subjects:
Sample type, size:
A purposive sample type was used to recruit 360 mothers who had a history of GDM and fulfilled the inclusion criteria; women without any medical complications and women at age between 18 - 45 years.
Sample Technique:
n= (Z2 P(1-P))/d2
z= level of confidence. (For the level of confidence of 95%, which is conventional, Z value is 1.96).
P= expected prevalence or proportion. (P is considered 0.5)
d=precision. (d is considered 0.05 to produce good precision and smaller error of estimate)
Tool of data collection:
I: Structured interviewing questionnaire (Appendix I) named “Mothers’ knowledge regarding postpartum screening for and factors affecting their compliance with Post-partum glucose screening”. It was developed by the researcher in a simple Arabic language after reviewing the most recent related literature. It consisted of 4 parts as follow:
Part I: was concerned with the assessment of general characteristics of subjects under study which included 6 open and closed-ended questions assessed these items: (age, marital status, place of residence, academic educational level, occupational status of the mother, medical insurance.
Part II: was used to assess the obstetric and gynecological present history of the mother, which included 15 open and closed-ended questions such as (Parity, Gravidity, number of living birth, abortion, history of follow-up during pregnancy, mode and place of delivery, and newborn feeding method).
Part III: was consisted of the assessment of women’s knowledge regarding gestational diabetes Mellitus (GDM) and postpartum screening for diabetes. Which included 12 open and closed-ended questions related to their knowledge about GDM, risk factors for acquiring GDM during pregnancy, signs of elevated blood glucose level, signs of decreased blood glucose level, effects of GDM on mothers, effects of GDM on the fetus, glucose level screening during pregnancy, complications of GDM on mothers and fetus during pregnancy, delivery and postpartum, women’s knowledge regarding post-partum glucose screening, the timing of the screening after delivery, the importance of the test and it’s types.
Scoring system:
Scoring system for women’s knowledge regarding GDM and post-partum glucose screening:
The correct answer had a score of (2), while the incorrect one had a score of (1). Subsequently, the total knowledge score was calculated then, total knowledge was converted into correct knowledge equal 60 % or more, while incorrect knowledge if less than 60%.
Part IV: was concerned with ”Factors that affect mothers’ compliance with postpartum glucose screening”. Which included four main factors: such as women factors, health care system factors, test factors, and social factors. All questions were closed-ended questions that could be a reason hindering their compliance with post-partum glucose screening.
Scoring system:
Scoring system for women’s compliance and non –compliance to the postpartum glucose screening.
Comply was given a (2) score. While not comply was given (1) score
Total scores were calculated then converted into two categories; compliance if equal to 60 % or more, while non-compliance if less than 60%.
Fieldwork:
During this phase, the researcher visited the previously mentioned study setting three times per week from 9:00 a.m. to 2:00 p.m. to collect data for twelve months, beginning January 1, 2020, and ending December 31, 2020.
The researchers introduced themselves and explained the goal of the study to the women being studied at the start of the interview to acquire their trust and verbal consent. In the postpartum unit of the Ain Shams Maternity Hospital, researchers interviewed postpartum mothers who met the sample requirements individually.
Every day, an average of 5-9 women are questioned and fill out the interview questionnaire to examine women’s general characteristics, obstetric and gynecological, medical history and GDM experience. Each mother was requested to provide a phone number by the researchers. After they’ve been discharged, keep track of them and complete the fourth and fifth phases of the data collection. Each interview lasts for a total of 25 minutes. Researchers called each woman to learn about their postpartum blood glucose screening results and to examine factors that might affect their compliance with postpartum blood glucose screening. The researcher repeats the processes above until the sample size specified previously is reached.
Results:
The results of this study showed that 59.2% of the study samples had incorrect overall knowledge of postpartum blood glucose screening (PPGS). 75% of the study samples did not comply with the postpartum glucose screening. A statistically significant relationship was observed between the compliance of the studied sample and the total factors of PPGS affecting their compliance