The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol

The long-term general practice healthcare of... | HRB Open Research dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); const cookieDomain = window.location.hostname; const tld = buildTLD(); function buildTLD() { const domainParts = cookieDomain.split('.'); while (domainParts.length > 2) { domainParts.shift(); } return domainParts.join('.'); } function deleteCookie(cookieName) { if (!cookieName) { return; } const cookiePath = (cookieName.startsWith('retraction_warning_') || cookieName.startsWith('version_warning_')) ? '/articles/' + cookieName : '/'; // Yes, these three slightly different ways to try and remove cookies are necessary document.cookie = cookieName + '=; path=' + cookiePath + '; domain=' + cookieDomain + '; expires=Thu, 01 Jan 1970 00:00:01 GMT;'; document.cookie = cookieName + '=; path=' + cookiePath + '; domain=.' + tld + '; expires=Thu, 01 Jan 1970 00:00:01 GMT;'; document.cookie = cookieName + '=; path=' + cookiePath + '; expires=Thu, 01 Jan 1970 00:00:01 GMT;'; } function deleteGroupCookies(group) { if (!group) { return; } const domainData = OneTrust.GetDomainData(), cookies = domainData.Groups.filter(cookieGroup => cookieGroup.OptanonGroupId === group)[0].Cookies; cookies.forEach(cookie => deleteCookie(cookie.Name)); } function OptanonWrapper() { const cookieConsentGroups = []; for (group of OneTrust.GetDomainData().Groups) { cookieConsentGroups.push(group.OptanonGroupId); } OneTrust.OnConsentChanged(function(e) { const cookieConsentActiveGroups = OnetrustActiveGroups.split(',').filter(activeGroup => activeGroup); cookieConsentGroups.forEach(group => { if (!cookieConsentActiveGroups.includes(group)) { deleteGroupCookies(group); }; }); }); } window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://hrbopenresearch.org/js/vendor/ckeditor/' window.reactTheme = 'HRB'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); Skip to content HRB Open Research file_upload Submit your research search clear search menu close clear Search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Data Guidelines Prepublication Checks Production Process Article Processing Charges Finding Article Reviewers About How it Works For Reviewers National Steering Group Policies Glossary FAQs Contact Blog My Account Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://hrbopenresearch.org/articles/8-31" }, "headline": "The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review...", "datePublished": "2025-02-11T12:33:20", "dateModified": "2025-04-10T11:44:40", "author": [ { "@type": "Person", "name": "James O'Flynn" }, { "@type": "Person", "name": "Rita McMorrow" }, { "@type": "Person", "name": "Tony Foley" }, { "@type": "Person", "name": "Rita Forde" }, { "@type": "Person", "name": "Sheena McHugh" }, { "@type": "Person", "name": "Christine Newman" }, { "@type": "Person", "name": "Aisling A. Jennings" } ], "publisher": { "@type": "Organization", "name": "HRB Open Research", "logo": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 566, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 1200, "width": 127 }, "description": " Introduction Gestational Diabetes Mellitus (GDM) is a hyperglycaemic condition diagnosed during pregnancy. GDM is strongly associated with future development of type 2 diabetes and cardiovascular disease. Lifestyle and pharmacological interventions can reduce the risk of developing type 2 diabetes. General practice is the recommended setting for long-term follow-up of women with a history of GDM. However, rates of follow-up are suboptimal. The evidence around long-term general practice healthcare for women with a history of GDM has not previously been reviewed. Aims The aim of this scoping review is to explore the current evidence base for the long-term care of women with a history of GDM in general practice. Study Design The study described by this protocol is a scoping review. The study design was informed by Joanna Briggs Institute methodology. Methods Empirical qualitative and quantitative research studies published since 2014 will be identified from a search of the following databases: MEDLINE (Ovid), EMBASE (Elsevier), CINAHL, PsycINFO, Academic Search Complete and SocIndex. The review will identify key characteristics of the literature. Framework analysis will be used to map the findings against the Chronic Care Model, a primary care-based framework that sets out the core components for optimal long-term healthcare. Results A numerical descriptive summary (using frequencies) will describe the overall extent of literature, and the range and distribution of its component parts, including the geographical and economic settings, research methods, interventions, outcomes and findings. The qualitative analysis will map interventions and descriptions of care to components of the chronic care model. Research gaps will be reported, and research needs and priorities will be suggested. Conclusion The findings of this scoping review will have the potential to inform future research efforts in the area. Registration This protocol has been registered in Open Science Framework (https://osf.io/bz2vh). " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://hrbopenresearch.org/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://hrbopenresearch.org/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://hrbopenresearch.org/articles/8-31/v2", "name": "The long-term general practice healthcare of women with a history..." } } ] } Home Browse The long-term general practice healthcare of women with a history... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article O'Flynn J, McMorrow R, Foley T et al. The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.12688/hrbopenres.14022.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Study Protocol Revised The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] James O'Flynn https://orcid.org/0009-0001-8348-6645 1 , Rita McMorrow 1,2 , Tony Foley https://orcid.org/0000-0003-3205-3871 1 , [...] Rita Forde https://orcid.org/0000-0003-1906-2431 3 , Sheena McHugh https://orcid.org/0000-0002-6595-0491 4 , Christine Newman 5,6 , Aisling A. Jennings https://orcid.org/0000-0002-9246-3955 1 James O'Flynn https://orcid.org/0009-0001-8348-6645 1 , Rita McMorrow 1,2 , [...] Tony Foley https://orcid.org/0000-0003-3205-3871 1 , Rita Forde https://orcid.org/0000-0003-1906-2431 3 , Sheena McHugh https://orcid.org/0000-0002-6595-0491 4 , Christine Newman 5,6 , Aisling A. Jennings https://orcid.org/0000-0002-9246-3955 1 PUBLISHED 10 Apr 2025 Author details Author details 1 Department of General Practice, University College Cork School of Medicine, Cork, T12 XF62, Ireland 2 The Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia 3 School of Nursing and Midwifery, University College Cork, Cork, T12 XF62, Ireland 4 School of Public Health, University College Cork, Cork, T12 XF62, Ireland 5 School of Medicine, College of Nursing, Midwifery and Health Science, University of Galway, Galway, H91 TK33, Ireland 6 Diabetes Collaborative Clinical Trial Network, University of Galway, Galway, H91 TK33, Ireland James O'Flynn Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Rita McMorrow Roles: Methodology, Writing – Review & Editing Tony Foley Roles: Conceptualization, Methodology, Writing – Review & Editing Rita Forde Roles: Methodology, Writing – Review & Editing Sheena McHugh Roles: Methodology, Writing – Review & Editing Christine Newman Roles: Methodology, Writing – Review & Editing Aisling A. Jennings Roles: Conceptualization, Funding Acquisition, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Introduction Gestational Diabetes Mellitus (GDM) is a hyperglycaemic condition diagnosed during pregnancy. GDM is strongly associated with future development of type 2 diabetes and cardiovascular disease. Lifestyle and pharmacological interventions can reduce the risk of developing type 2 diabetes. General practice is the recommended setting for long-term follow-up of women with a history of GDM. However, rates of follow-up are suboptimal. The evidence around long-term general practice healthcare for women with a history of GDM has not previously been reviewed. Aims The aim of this scoping review is to explore the current evidence base for the long-term care of women with a history of GDM in general practice. Study Design The study described by this protocol is a scoping review. The study design was informed by Joanna Briggs Institute methodology. Methods Empirical qualitative and quantitative research studies published since 2014 will be identified from a search of the following databases: MEDLINE (Ovid), EMBASE (Elsevier), CINAHL, PsycINFO, Academic Search Complete and SocIndex. The review will identify key characteristics of the literature. Framework analysis will be used to map the findings against the Chronic Care Model, a primary care-based framework that sets out the core components for optimal long-term healthcare. Results A numerical descriptive summary (using frequencies) will describe the overall extent of literature, and the range and distribution of its component parts, including the geographical and economic settings, research methods, interventions, outcomes and findings. The qualitative analysis will map interventions and descriptions of care to components of the chronic care model. Research gaps will be reported, and research needs and priorities will be suggested. Conclusion The findings of this scoping review will have the potential to inform future research efforts in the area. Registration This protocol has been registered in Open Science Framework ( https://osf.io/bz2vh ). READ ALL READ LESS Keywords Gestational Diabetes Mellitus, Follow-Up, General Practice, Primary Care, Scoping Review, Type 2 Diabetes Mellitus Corresponding Author(s) James O'Flynn ( [email protected] ) Close Corresponding author: James O'Flynn Competing interests: No competing interests were disclosed. Grant information: This scoping review is funded by the Irish College of General Practitioners (ICGP) Post-CSCST Fellowship in Gestational Diabetes. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 O'Flynn J et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: O'Flynn J, McMorrow R, Foley T et al. The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.12688/hrbopenres.14022.2 ) First published: 11 Feb 2025, 8 :31 ( https://doi.org/10.12688/hrbopenres.14022.1 ) Latest published: 10 Apr 2025, 8 :31 ( https://doi.org/10.12688/hrbopenres.14022.2 ) Revised Amendments from Version 1 The second version of this protocol follows peer review and includes several changes. The introduction has undergone minor revision to enhance clarity regarding the subject area. We have included updated evidence by Foo and colleagues regarding the emerging link between gestational diabetes and hepatic steatosis. We have also included a meta-analysis by Lee and colleagues identifying the limitations within interventional evidence for this population. Preconception care and efforts to reduce the risk of recurrence of GDM are included. Diabetes prevention programmes are a potentially important aspect of the healthcare landscape for this high-risk population, and we have included this point in the introduction. We have made no major adjustments to the methodology, but have included clarifications. We have clarified that we aim to map research evidence around the subject area, rather than directly evaluate health services. The time-frame used to define long-term care is described as beginning after the early postpartum period, independent of the occurrence of screening. However, we have chosen not to specify a timepoint as a cut-off, as this may result in the exclusion of some relevant studies conducted relatively early in the post-partum period, but which adopt a long-term perspective. There is no upper limit to this time-frame, and we have underscored our interest in examining the lifelong healthcare of these women. We have added an explicit justification for our decision to exclude studies published over the last 10 years (2014 or later), noting the rapid evolution of the healthcare landscape and the need to allow sufficient time to integrate the findings of the 2008 Hyperglycaemia and Adverse Pregnancy Outcomes study. We have also more clearly stated our intent to omit grey literature. The second version of this protocol follows peer review and includes several changes. The introduction has undergone minor revision to enhance clarity regarding the subject area. We have included updated evidence by Foo and colleagues regarding the emerging link between gestational diabetes and hepatic steatosis. We have also included a meta-analysis by Lee and colleagues identifying the limitations within interventional evidence for this population. Preconception care and efforts to reduce the risk of recurrence of GDM are included. Diabetes prevention programmes are a potentially important aspect of the healthcare landscape for this high-risk population, and we have included this point in the introduction. We have made no major adjustments to the methodology, but have included clarifications. We have clarified that we aim to map research evidence around the subject area, rather than directly evaluate health services. The time-frame used to define long-term care is described as beginning after the early postpartum period, independent of the occurrence of screening. However, we have chosen not to specify a timepoint as a cut-off, as this may result in the exclusion of some relevant studies conducted relatively early in the post-partum period, but which adopt a long-term perspective. There is no upper limit to this time-frame, and we have underscored our interest in examining the lifelong healthcare of these women. We have added an explicit justification for our decision to exclude studies published over the last 10 years (2014 or later), noting the rapid evolution of the healthcare landscape and the need to allow sufficient time to integrate the findings of the 2008 Hyperglycaemia and Adverse Pregnancy Outcomes study. We have also more clearly stated our intent to omit grey literature. See the authors' detailed response to the review by Angela Flynn See the authors' detailed response to the review by Alpesh Goyal READ REVIEWER RESPONSES Introduction Gestational Diabetes Mellitus (GDM) is a hyperglycaemic condition with onset or first recognition during pregnancy 1 . The prevalence of GDM is estimated to be at 14% of pregnancies globally using the International Association of Diabetes in Pregnancy Study Group diagnostic criteria 2 . The prevalence is increasing, which has been linked to advancing maternal age and rising obesity rates 3 , 4 . GDM is associated with pregnancy complications for both mother and foetus, such as macrosomia and pre-eclampsia 5 – 7 . Pregnancy and perinatal GDM management is associated with increased economic costs 8 – 10 . Rates of GDM in subsequent pregnancies are between 30% and 84% 11 . GDM further presents enduring health risks for women after pregnancy. Women who experience GDM have an approximately tenfold risk of later developing type 2 diabetes 12 , 13 . It has been estimated that up to one in three women with type 2 diabetes experienced a pregnancy which was complicated by GDM 14 . Even in the absence of diabetes, GDM is associated with increased cardiovascular risks, including ischaemic heart disease, heart failure, thromboembolic disease and stroke 15 , 16 . Emerging research suggests potential links between GDM and increased rates of other conditions, including hepatic steatosis, renal disease and cancers of the breast, reproductive tract and thyroid 17 – 21 . A greater susceptibility to obesity and metabolic syndrome has also been identified among children of women with a history of GDM 22 , 23 . Consequently, GDM carries the potential for lifelong health consequences for the mother as well as intergenerational health implications 24 , 25 . To date, research relating to the management of GDM has primarily focused on pregnancy and early postpartum care after a diagnosis of GDM. Interventions aimed at preventing type 2 diabetes after a GDM diagnosis include lifestyle, education and medication 26 . A recent meta-analysis found that the hazard ratio of type 2 diabetes was significantly improved by interventions, while the relative risk did not achieve significance 27 . This may occur if the effect of interventions is time-dependent, and may suggest that their effect may more readily delay than outright prevent the onset of type 2 diabetes. Evidence syntheses indicate that interventions to support healthy diet and physical activity for women with a history of GDM may result in improvements in glycaemic measures and adiposity, with lower rates of subsequent type 2 diabetes 28 – 32 . However, these results have not consistently achieved statistical significance. Studies report multiple barriers for women engaging with lifestyle interventions, including maternal tiredness, competing occupational and family demands, and personal risk perception 33 , 34 . Educational interventions targeting postpartum women with a history of GDM have not predominantly been studied in isolation, and have been used primarily as an adjunct to or vehicle for diet and physical activity interventions 35 – 39 . Limited pharmacological studies have primarily examined glucose-lowering therapies. Meta-analyses inconsistently identify modest reductions in hyperglycaemia and progression to type 2 diabetes, though large scale and long-term data is lacking 26 , 27 , 40 , 41 . Deficits in the reporting of socioeconomic factors in the evidence for prevention of type 2 diabetes for women with a history of GDM has previously been demonstrated 42 . Despite the limitations of the evidence for optimal long-term interventions for this population, economic analyses have found that interventions designed to prevent the development of type 2 diabetes for women with a history of GDM appear cost-effective 43 , 44 . Data regarding the role for preconception care aimed at reducing the risk of GDM recurrence are also lacking 45 – 47 . In spite of this, clinical practice guidelines frequently identify the importance of family planning and contraception for women with a history of GDM 48 . To the best of our knowledge, the effects of interventions on the prevention of other diseases associated with GDM, such as cardiovascular disease, have not been studied 49 . Due to the long-term risks associated with GDM and the opportunities for subsequent disease prevention, clinical practice guidelines recommend regular long-term follow-up healthcare. This may include lifelong regular screening for early diagnosis of diabetes or cardiovascular disease, and ongoing support for maintenance of positive health behaviours 41 , 50 – 52 . Despite this, evidence suggests that rates of long-term follow-up of women who have been diagnosed with GDM are suboptimal, with less than half of women receiving follow-up diabetes screening after 1 year postpartum 53 – 55 . General practice (GP) has been identified as an appropriate setting for long-term follow-up care of women with a history of GDM 24 , 56 . GPs can provide direct support and can connect women with parallel services, including Diabetes Prevention Programmes 57 , 58 . A descriptive cross-sectional survey conducted in Canada found that three quarters of women with a history of GDM appear satisfied to transition to primary care-based settings after pregnancy 59 , 60 . However, fragmentation of care, deficits in interprofessional communication and uncertainty regarding professional roles and responsibilities can impact on the long-term care provided to these women 59 , 61 , 62 . Optimal models of care and factors influencing their delivery have not been established. To our knowledge there have been no systematic attempts to provide an overview of the available research evidence on the long-term general practice-based healthcare of women with a history of GDM. Therefore, a comprehensive understanding of long-term general practice healthcare for women with a history of GDM is required if the rates and quality of follow-up are to be improved. The aim of this scoping review is to explore the current evidence base for the long-term care of women with a history of GDM in general practice. Objectives What are the extent, nature and key characteristics of research exploring long-term GP-based healthcare for women with a history of GDM, including: - The experiences and perspectives of women with a history of GDM and their GPs - Interventions studied in a GP setting, with particular focus on the range of interventions, the reporting of interventions and the reporting of socioeconomic characteristics of study populations - Outcomes studied, with particular focus on physical outcomes to include the prevention of type 2 diabetes and cardiovascular disease and psychological outcomes - What areas of the healthcare system are well-researched, and where are there research gaps, employing the Chronic Care Model as a guiding framework Methods The JBI Manual for Evidence Synthesis builds on previous scoping review methodological frameworks, most notably Arksey and O’Malley, and will guide this scoping review protocol 63 , 64 . Guidance will also be taken from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol framework 65 . Eligibility criteria Studies will be selected according to the criteria outlined in Table 1 . Explanation of the criteria follows. Table 1. Eligibility criteria for studies in the scoping review. Category Inclusion Criteria Exclusion Criteria Population Non-pregnant adults with a previous history of GDM, diagnosed using established criteria People living with other forms of diabetes Offspring of women with a history of GDM Concept Research examining any characteristic of healthcare occurring after initial post-partum glycaemia screening Studies examining initial post-partum glycaemia screening only Studies that do not describe or evaluate healthcare following a diagnosis of GDM Context General Practice in any geographical or economic setting Studies not based in general practice, including healthcare delivered in the community, home, hospital or through the internet Healthcare services led by specialists other than general practice (e.g. dietetics, physiotherapy, midwifery) Language Any None Types of Evidence Sources Peer reviewed Empirical research including: Qualitative research Quantitative research Mixed-methods research Economic analyses Case reports Case series Opinion pieces Evidence syntheses Position papers Clinical practice guidelines Policy documents Dissertations or theses Population We will include studies examining general practice healthcare of non-pregnant adults with a previous history of GDM. Heterogenous screening approaches and diagnostic criteria are used for GDM, with variations of oral glucose tolerance testing and the associated diagnostic thresholds adopted by different clinical practice guidelines 66 . Studies including any internationally accepted criteria for the diagnosis of GDM will be accepted. Studies involving adults with prediabetes after a GDM diagnosis, established type 2 diabetes after a GDM diagnosis, pre-existing diabetes, or other forms of diabetes will be excluded. For the purposes of this review, due to the absence of clinical guideline recommendations for structured long-term follow-up of children of women with a history of GDM, studies involving children will be excluded unless maternal general practice healthcare is also addressed in the study. Concept We will review research studies which investigate long-term healthcare of women with a history of GDM in general practice. This may include general practice-based research on interventions for prevention of diseases including GDM recurrence, type 2 diabetes or cardiovascular disease following GDM, as well as processes for screening or diagnosis of such conditions. We will also include studies examining factors that increase or decrease rates of the delivery and uptake of GP healthcare. We will include studies examining interactions between GPs and women with a history of GDM, or GPs and other health professionals regarding the care of these women. We will include studies exploring stakeholder perspectives of care in general practice. Stakeholders may include GPs, GP staff or women with a history of GDM receiving GP care. Educational interventions targeting GPs and GP staff will be included. Studies of care pathways or care programmes and economic analyses of long-term general practice healthcare for women with a history of GDM will be included. Studies that compare long-term general practice healthcare for women with a history of GDM with other forms of healthcare will be included. We will exclude studies examining early post-partum follow-up care. Long-term healthcare for women with a history of GDM will be defined for this study as healthcare provided beyond the early postpartum period. Context Studies included in this review will involve general practice settings, defined according to the WONCA definition 67 . This will exclude community- or home-based interventions aimed at promoting self-management only. This will also exclude evidence pertaining to hospital or specialist care only. Interventional studies carried out through research institutions or universities will be excluded if they are not delivered within a clinical general practice setting. Other forms of primary care, such as dietitian-led care, will not be included in this review. Studies occurring in any geographical and economic context will be considered, provided the care occurs within a general practice setting. Language No language restrictions will be applied. Non-English language studies will be translated using freely available proprietary translation software programmes. Initial translation will be carried out using Google Translate, with unclear translations being cross-checked with CUBITT translation 68 , 69 . Types of evidence sources This scoping review will include published empirical qualitative, quantitative or mixed-methods studies. Economic analyses will be included. Primary sources cited by evidence syntheses arising from the search process will be included, but the evidence syntheses themselves will not be included. Grey literature will not be included. Case reports, case series and opinion pieces will not be included. We will exclude clinical practice guidelines, policy documents and the position papers of scientific bodies. We will exclude dissertations and PhD theses. Search strategy A health information specialist with experience in scoping reviews was consulted in the design of the search strategy. The three-step search approach recommended by JBI will be used 64 . After an initial search to assess relevant keywords and indexing terms, the search strategy was developed using medical subject headings (MeSH) and natural language text words or phrases related to the core concepts of GDM, GP and a Long-Term timeframe. We will search MEDLINE (Ovid), EMBASE (Elsevier), CINAHL, PsycINFO, Academic Search Complete and SocIndex. The search terms for MEDLINE (Ovid) are provided in Table 2 . To accommodate the rapidly evolving healthcare landscape, and to permit permeation of the practice-changing findings of the Hyperglycemia and Adverse Pregnancy Outcomes study 2008, the search years will be limited to the past 10 years (2014 or later) 70 . To ensure a comprehensive search of published literature, reference lists and studies citing the accepted papers will be scanned. The reference lists of systematic reviews identified in the search will also be scanned. Table 2. Search (MEDLINE (Ovid)). Query 1 ("Gestational Diabetes" or GDM or "Pregnancy-Induced Diabetes" or (Pregnancy and (Diabetes or Hyperglycaemia or Dysglycaemia or "Glucose intolerance" or "Impaired glucose tolerance"))).ti. or ("Gestational Diabetes" or GDM or "Pregnancy- Induced Diabetes" or (Pregnancy and (Diabetes or Hyperglycaemia or Dysglycaemia or "Glucose intolerance" or "Impaired glucose tolerance"))).ab. 2 (Long-Term or "Long Term" or Follow-up or "Follow up" or "longitudinal" or "Chronic disease management" or "late complications" or "delayed effects").ti. or (Long-Term or "Long Term" or Follow-up or "Follow up" or "longitudinal" or "Chronic disease management" or "late complications" or "delayed effects").ab. 3 ("General Practice" or "General Practitioners" or "GP" or "Family medicine" or "Family Physicians" or "FP" or "Primary Care" or "Primary Healthcare" or "PCP").ti.or ("General Practice" or "General Practitioners" or "GP" or "Family medicine" or "Family Physicians" or "FP" or "Primary Care" or "Primary Healthcare" or "PCP").ab. 4 Diabetes, Gestational.sh. 5 (Follow-up Studies or Chronic Disease).sh. 6 (General Practice or General Practitioners or Primary Health Care or Physicians, Primary Care or Family Practice or Physicians, Family).sh. 7 1 or 4 8 2 or 5 9 3 or 6 10 7 and 8 and 9 Source of evidence selection Results will be managed with the systematic review tool, Covidence ( www.covidence.org ). A pilot selection process will be conducted on 100 papers to refine the process, according to JBI recommendations. Full screening will proceed once agreement is at least 75%. After the full search is completed, two reviewers will independently conduct screening according to the eligibility criteria (RMcM, JOF). Initial title and abstract screening will be followed by full text screening of apparently eligible articles. Disagreements will be resolved by consensus or by a third reviewer (AJ). If additional information is required from authors to confirm eligibility status of a source, the corresponding author will be contacted by e-mail. Reasons for exclusion of full text sources will be recorded. The numbers of citations identified, duplicates removed, additions via alternative sources, records screened, and full text reviews will be reported. Inter-rater agreement for the screening of search results will be reported. The report of the selection process will be accompanied by a visual flowchart according to the PRISMA extension for scoping reviews 71 . Data extraction and analysis Descriptive numerical summary For the descriptive numerical summary of studies included in this review, data extraction will be developed and piloted to record the key information from each source 63 . The process is intended to map key features of the literature, such as study design, aims, methods, intervention type (if applicable) and key findings 63 , 72 . The factors for inclusion on the initial data extraction form are included in Table 3 . The items chosen are suggested in the JBI methodology, and minor additions are included here. We will record studies’ reporting of population characteristics according to the PROGRESS framework. This framework is used to identify key population factors influencing equity of outcomes, which are place of residence, race, occupation, gender, religion, education, socioeconomic status and social capital 73 . Reporting of these items permits assessment of inequity within a study 74 . The presence of an equity assessment within research is desired by policymakers 75 . Intervention descriptions and outcome details will be extracted from interventional studies. We will record the reporting of interventions in studies according to the Template for Intervention Description and Replication (TIDieR), a 12-item tool designed to improve the completeness of reporting of interventions 76 . Outcomes will be categorised according to the core outcome sets designed for the reporting of interventional studies in this population 77 , 78 . Psychological or emotional outcomes will be included in addition to the core outcome set items. This activity will be refined iteratively at the review stage by one author (JOF) applying the initial data extraction form to five to ten papers. Two authors (CN, JOF) will discuss and adjust until the forms are used consistently, and the data emerging contribute to answering the research question 72 . Table 3. Factors for inclusion on the initial data extraction form. Item Data for Extraction Author First author Year of Publication Year Setting Country / Countries Economic developmental category (according to the World Bank’s Gross National Income per capita) Aims / Purpose Self-identified aim Methodology Methodological design Population (if applicable) Sample Size Subgroup items reported (PROGRESS) Duration of follow-up (if applicable) Intervention (if applicable) Intervention description (TIDieR) Duration of intervention Outcome (if applicable) Primary Outcomes Secondary Outcomes Key Findings Key Findings PROGRESS subgroup differences Research Recommendations Author Recommendations for Future Research Analysis of the extracted data will involve the use of descriptive statistics to provide an overview of the included studies according to their key characteristics. Frequencies will be the predominant statistical method used. For evaluations of interventional studies, the frequencies of outcomes reported in relation to the core outcome set will also be described. Qualitative mapping The qualitative arm of the review will systematically categorise and map findings from included studies. A framework synthesis will be conducted 64 , 79 , 80 . Framework methodologies use a highly structured, transparent approach to mapping data in a manner appropriate to scoping reviews 64 , 80 . The components of the Chronic Care Model will be used as a ‘Best Fit' a priori framework based methods described by Carroll and colleagues 81 , 82 . The Chronic Care Model is a primary care-based theoretical model which sets out the core components of a system of high-quality chronic disease management 83 – 85 . These components are the community linkage, the self-management support, organisation of healthcare delivery system, delivery system design, decision support and clinical information systems 83 , 84 . Implementation of these components is associated with benefits for people with a history of type 2 diabetes 85 – 89 . Adoption of the Chronic Care Model in the design of approaches to the diabetes management has been recommended by the American Diabetes Association 90 . No pre-existing theoretical frameworks specifically designed for understanding the care of women with a history of GDM were identified by the authors. The qualitative analysis and mapping will involve four authors (RF, AJ, RM, JOF). One researcher (JOF) will extract the relevant text data from all included studies to word processing software (Microsoft Word). The units of analysis will be the intervention descriptions, verbatim quotations from participants in primary studies, and the qualitative findings of the studies. NVivo software ( www.lumivero.com ) will be used for the coding process. Two authors (RF, JOF) will conduct a pilot coding process on two papers. This will involve line-by-line deductive coding of the extracted data against the a priori framework 81 , 82 . Existing definitions of the Chronic Care Model components will be used to guide the coding and categorisation. Team discussion will be used to specify subcategories that will further contribute to characterising the distribution of data in this subject area. Extracted data not accommodated by the framework will be inductively coded 82 , 91 . The pilot coding will be subject to discussion among the review team regarding the coding rationale and its alignment with the research objective. The research team will meet to discuss the coding after this initial pilot. One author (JOF) will then independently conduct coding of the full dataset. Data charting involves rearranging the coded data according to the framework components 79 , 80 . Coded data will be charted, and inductive codes not falling within the framework will be gathered for consideration of significant new concepts 81 . The research team will meet regularly and collectively interpret and map charted and inductively coded data, with particular focus on implications for the research question 79 – 81 . A final “map” that describes the evidence will then be produced in the form of a narrative summary. Gaps, needs and priorities Research gaps are areas where insufficient evidence prevents the formation of conclusions for a given research question 92 . Research needs are gaps that may inhibit stakeholder decision-making, while research priorities are gaps prioritised due to resource constraints 92 . Systematic methodologies for identifying gaps may also incorporate assessments of the quality of evidence beyond the scope of a scoping review 64 , 93 . In this case, gaps will be identified only from areas of absence or sparsity of findings in the descriptive numerical summary, outcome reporting and qualitative map 93 . Gaps will be reported according to the pertinent areas of inadequacy using the population, intervention, comparison, outcome and setting framework (PICOS) 93 , 94 . Stakeholder consultation is an approach frequently used to identifying needs and priorities 92 , 94 . Potential research needs and priorities will be proposed from discussion of the review findings among the current multidisciplinary research team, comprised of individuals from several important stakeholder groups on the topic: general practice, public health, health services research, nursing and endocrinology. Research recommendations stated within the reports of included studies will be identified through the data extraction process, as included in Table 3 . These recommendations will further inform the proposal of potential research needs and priorities. Reporting The PRISMA extension for Scoping Reviews (PRISMA-ScR) will be used to guide the report 71 . Dissemination plan The intended audiences for this study will be researchers, health care professionals and policymakers who are involved in contributing to the structure of healthcare for women with a history of GDM, as well as the women themselves. This study will be submitted for publication in a peer-reviewed scientific journal and for scientific conference presentation. A plain English summary will be produced for women with a history of GDM. Discussion This review will synthesise research evidence on the long-term healthcare for women with a history of GDM in general practice. This corresponds with recent interest in a longitudinal perspective on GDM 24 . The methods detailed in this study protocol will provide transparency to the study’s findings. Incorporating both qualitative and quantitative papers, and the use of a well-established theoretical model, the chronic care model, will strengthen the findings of the paper. However, because no previous theoretical models have been applied to the healthcare of women with a history of GDM, the study may identify a need for a new, tailored model to understand long-term healthcare for women with a history of GDM. The use of a multidisciplinary research team with expertise from General Practice, Endocrinology, Nursing and Public Health will further strengthen the paper’s methodology and the interpretation of its results. Future research studies will be guided towards research gaps identified in this study. Conclusion This paper outlines a study protocol for a scoping review on the topic of GP healthcare for women with a history of GDM. The review will provide a synthesis of the current research evidence on the topic, and research recommendations regarding long-term follow-up of women with GDM in general practice. Ethics and consent Ethical approval and consent were not required. Data availability Underlying data No data are associated with this article. Contributions James O’Flynn, Roles: Conceptualisation, Methodology, Writing – Original draft preparation, Writing – Review and editing Rita McMorrow, Roles: Methodology, Writing – Review and editing Tony Foley, Roles: Conceptualisation, Methodology, Writing - Review and editing Rita Forde, Roles: Methodology, Writing - Review and editing Sheena McHugh, Roles: Methodology, Writing - Review and editing Christine Newman, Roles: Methodology, Writing - Review and editing Aisling A. Jennings, Roles: Funding Acquisition, Conceptualisation, Methodology, Writing – Review and editing, Supervision Acknowledgements The authors gratefully acknowledge Patricia Patton of the Irish College of General Practitioners Library Services for her expert contribution to the design of the literature search strategy. Faculty Opinions recommended References 1. American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009; 32 Suppl 1 (Suppl 1): S62–7. PubMed Abstract | Publisher Full Text | Free Full Text 2. Wang H, Li N, Chivese T, et al. : IDF diabetes atlas: estimation of global and regional Gestational Diabetes Mellitus prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s criteria. Diabetes Res Clin Pract. 2022; 183 : 109050. PubMed Abstract | Publisher Full Text 3. Gortazar L, Flores-Le Roux JA, Benaiges D, et al. : Trends in prevalence of gestational diabetes and perinatal outcomes in Catalonia, Spain, 2006 to 2015: the diagestcat study. Diabetes Metab Res Rev. 2019; 35 (5): e3151. PubMed Abstract | Publisher Full Text 4. Lavery J, Friedman A, Keyes K, et al. : Gestational diabetes in the United States: temporal changes in prevalence rates between 1979 and 2010. BJOG. 2017; 124 (5): 804–13. PubMed Abstract | Publisher Full Text | Free Full Text 5. Johns EC, Denison FC, Norman JE, et al. : Gestational Diabetes Mellitus: mechanisms, treatment, and complications. Trends Endocrinol Metab. 2018; 29 (11): 743–54. PubMed Abstract | Publisher Full Text 6. Yang Y, Wu N: Gestational Diabetes Mellitus and Preeclampsia: correlation and influencing factors. Front Cardiovasc Med. 2022; 9 : 831297. PubMed Abstract | Publisher Full Text | Free Full Text 7. Ye W, Luo C, Huang J, et al. : Gestational Diabetes Mellitus and adverse pregnancy outcomes: systematic review and meta-analysis. BMJ. 2022; 377 : e067946. PubMed Abstract | Publisher Full Text | Free Full Text 8. Meregaglia M, Dainelli L, Banks H, et al. : The short-term economic burden of Gestational Diabetes Mellitus in Italy. BMC Pregnancy Childbirth. 2018; 18 (1): 58. PubMed Abstract | Publisher Full Text | Free Full Text 9. Sosa-Rubi SG, Dainelli L, Silva-Zolezzi I, et al. : Short-term health and economic burden of Gestational Diabetes Mellitus in Mexico: a modeling study. Diabetes Res Clin Pract. 2019; 153 : 114–24. PubMed Abstract | Publisher Full Text 10. Xu T, Dainelli L, Yu K, et al. : The short-term health and economic burden of Gestational Diabetes Mellitus in China: a modelling study. BMJ Open. 2017; 7 (12): e018893. PubMed Abstract | Publisher Full Text | Free Full Text 11. Kim C, Berger DK, Chamany S: Recurrence of Gestational Diabetes Mellitus: a systematic review. Diabetes Care. 2007; 30 (5): 1314–9. PubMed Abstract | Publisher Full Text 12. Gadve SS, Chavanda S, Mukherjee AD, et al. : Risk of developing type 2 diabetes mellitus in South Asian women with history of Gestational Diabetes Mellitus: a systematic review and meta-analysis. Indian J Endocrinol Metab. 2021; 25 (3): 176–81. PubMed Abstract | Publisher Full Text | Free Full Text 13. Vounzoulaki E, Khunti K, Abner SC, et al. : Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ. 2020; 369 : m1361. PubMed Abstract | Publisher Full Text | Free Full Text 14. Cheung NW, Byth K: Population health significance of gestational diabetes. Diabetes Care. 2003; 26 (7): 2005–9. PubMed Abstract | Publisher Full Text 15. Xie W, Wang Y, Xiao S, et al. : Association of Gestational Diabetes Mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis. BMJ. 2022; 378 : e070244. PubMed Abstract | Publisher Full Text | Free Full Text 16. Li J, Song C, Li C, et al. : Increased risk of cardiovascular disease in women with prior gestational diabetes: a systematic review and meta-analysis. Diabetes Res Clin Pract. 2018; 140 : 324–38. PubMed Abstract | Publisher Full Text 17. Foo RX, Ma JJ, Du R, et al. : Gestational Diabetes Mellitus and development of intergenerational Non-Alcoholic Fatty Liver Disease (NAFLD) after delivery: a systematic review and meta-analysis. eClinicalMedicine. 2024; 72 : 102609. PubMed Abstract | Publisher Full Text | Free Full Text 18. Tong GX, Cheng J, Chai J, et al. : Association between Gestational Diabetes Mellitus and subsequent risk of cancer: a systematic review of epidemiological studies. Asian Pac J Cancer Prev. 2014; 15 (10): 4265–9. PubMed Abstract | Publisher Full Text 19. Barrett PM, McCarthy FP, Kublickiene K, et al. : Adverse pregnancy outcomes and long-term maternal kidney disease: a systematic review and meta-analysis. JAMA Netw Open. 2020; 3 (2): e1920964. PubMed Abstract | Publisher Full Text 20. Flachs Madsen LR, Gerdøe-Kristensen S, Lauenborg J, et al. : Long-term follow-up on morbidity among women with a history of Gestational Diabetes Mellitus: a systematic review. J Clin Endocrinol Metab. 2022; 107 (9): 2411–23. PubMed Abstract | Publisher Full Text | Free Full Text 21. Slouha E, Gates KM, Al-Geizi H, et al. : The relationship between gestational diabetes and the risk of cancer: a systematic review. Cureus. 2024; 16 (1): e53328. PubMed Abstract | Publisher Full Text | Free Full Text 22. Lowe WL, Lowe LP, Kuang A, et al. : Maternal glucose levels during pregnancy and childhood adiposity in the hyperglycemia and adverse pregnancy outcome follow-up study. Diabetologia. 2019; 62 (4): 598–610. PubMed Abstract | Publisher Full Text | Free Full Text 23. Pathirana MM, Lassi ZS, Ali A, et al. : Association between metabolic syndrome and Gestational Diabetes Mellitus in women and their children: a systematic review and meta-analysis. Endocrine. 2021; 71 (2): 310–20. PubMed Abstract | Publisher Full Text 24. Simmons D, Gupta Y, Hernandez TL, et al. : Call to action for a life course approach. Lancet. 2024; 404 (10448): 193–214. PubMed Abstract | Publisher Full Text 25. Fu J, Retnakaran R: The life course perspective of gestational diabetes: an opportunity for the prevention of diabetes and heart disease in women. eClinicalMedicine. 2022; 45 : 101294. PubMed Abstract | Publisher Full Text | Free Full Text 26. Morton S, Kirkwood S, Thangaratinam S: Interventions to modify the progression to type 2 diabetes mellitus in women with gestational diabetes: a systematic review of literature. Curr Opin Obstet Gynecol. 2014; 26 (6): 476–86. PubMed Abstract | Publisher Full Text 27. Lee VY, Monjur MR, Santos JA, et al. : The efficacy of interventions to prevent type 2 diabetes among women with recent Gestational Diabetes Mellitus—A living systematic review and meta-analysis. J Diabetes. 2024; 16 (8): e13590. PubMed Abstract | Publisher Full Text | Free Full Text 28. Retnakaran M, Viana LV, Kramer CK: Lifestyle intervention for the prevention of type 2 diabetes in women with prior gestational diabetes: a systematic review and meta-analysis. Diabetes Obes Metab. 2023; 25 (5): 1196–202. PubMed Abstract | Publisher Full Text 29. D’Arcy E, Rayner J, Hodge A, et al. : The role of diet in the prevention of diabetes among women with prior gestational diabetes: a systematic review of intervention and observational studies. J Acad Nutr Diet. 2020; 120 (1): 69–85.e7. PubMed Abstract | Publisher Full Text 30. Wang Y, Wei W, Guo H, et al. : Postpartum life interventions to prevent type 2 diabetes in women with gestational diabetes: a systematic review and meta-analysis. J Diabetes Investig. 2024; 15 (8): 1115–28. PubMed Abstract | Publisher Full Text | Free Full Text 31. Guo J, Chen JL, Whittemore R, et al. : Postpartum lifestyle interventions to prevent type 2 diabetes among women with history of gestational diabetes: a systematic review of randomized clinical trials. J Womens Health (Larchmt). 2016; 25 (1): 38–49. PubMed Abstract | Publisher Full Text 32. Goveia P, Cañon-Montañez W, Santos DP, et al. : Lifestyle intervention for the prevention of diabetes in women with previous Gestational Diabetes Mellitus: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2018; 9 : 583. PubMed Abstract | Publisher Full Text | Free Full Text 33. Peacock AS, Bogossian F, McIntyre HD, et al. : A review of interventions to prevent type 2 diabetes after gestational diabetes. Women Birth. 2014; 27 (4): e7–15. PubMed Abstract | Publisher Full Text 34. Lie ML, Hayes L, Lewis-Barned NJ, et al. : Preventing type 2 diabetes after gestational diabetes: women’s experiences and implications for diabetes prevention interventions. Diabet Med. 2013; 30 (8): 986–93. PubMed Abstract | Publisher Full Text 35. Cheung NW, Blumenthal C, Smith BJ, et al. : A pilot randomised controlled trial of a text messaging intervention with customisation using linked data from wireless wearable activity monitors to improve risk factors following gestational diabetes. Nutrients. 2019; 11 (3): 590. PubMed Abstract | Publisher Full Text | Free Full Text 36. O’Reilly SL, Dunbar JA, Versace V, et al. : Mothers After Gestational Diabetes in Australia (MAGDA): a randomised controlled trial of a postnatal diabetes prevention program. PLoS Med. 2016; 13 (7): e1002092. PubMed Abstract | Publisher Full Text | Free Full Text 37. Holmes VA, Draffin CR, Patterson CC, et al. : Postnatal lifestyle intervention for overweight women with previous gestational diabetes: a randomized controlled trial. J Clin Endocrinol Metab. 2018; 103 (7): 2478–87. PubMed Abstract | Publisher Full Text 38. Zilberman-Kravits D, Meyerstein N, Abu-Rabia Y, et al. : The impact of a cultural lifestyle intervention on metabolic parameters after Gestational Diabetes Mellitus a randomized controlled trial. Matern Child Health J. 2018; 22 (6): 803–11. PubMed Abstract | Publisher Full Text 39. O’Dea A, Tierney M, McGuire BE, et al. : Can the onset of type 2 diabetes be delayed by a group-based lifestyle intervention in women with prediabetes following Gestational Diabetes Mellitus (GDM)? Findings from a randomized control mixed methods trial. J Diabetes Res. 2015; 2015 (1): 798460. PubMed Abstract | Publisher Full Text | Free Full Text 40. Dennison RA, Oliver-Williams C, Qi HLJ, et al. : The effectiveness of pharmacological and lifestyle interventions to reduce the risk of diabetes and hyperglycaemia following gestational diabetes: a systematic review and meta-analysis. Diabet Med. 2024; 41 (6): e15316. PubMed Abstract | Publisher Full Text 41. Recommendations: Diabetes in pregnancy: management from preconception to the postnatal period. Guidance, NICE, 2015; [cited 2024 Sep 9]. Reference Source 42. Ukke GG, Boyle JA, Reja A, et al. : Lifestyle interventions to prevent type 2 Diabetes in women with a history of gestational diabetes: a systematic review and meta-analysis through the lens of health equity. Nutrients. 2023; 15 (21): 4666. PubMed Abstract | Publisher Full Text | Free Full Text 43. Werbrouck A, Schmidt M, Putman K, et al. : A systematic review on costs and cost-effectiveness of screening and prevention of type 2 diabetes in women with prior gestational diabetes: exploring uncharted territory. Diabetes Res Clin Pract. 2019; 147 : 138–148. PubMed Abstract | Publisher Full Text 44. Li W, Kim CS, Howell EA, et al. : Economic evaluation of prenatal and postpartum care in women with gestational diabetes and Hypertensive Disorders of Pregnancy: a systematic review. Value Health. 2022; 25 (12): 2062–2080. PubMed Abstract | Publisher Full Text | Free Full Text 45. Phelan S, Jelalian E, Coustan D, et al. : Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of Gestational Diabetes Mellitus. Am J Obstet Gynecol. 2023; 229 (2): 158.e1–158.e14. PubMed Abstract | Publisher Full Text 46. Quotah OF, Andreeva D, Nowak KG, et al. : Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of Randomised Controlled Trials. Diabetol Metab Syndr. 2024; 16 (1): 8. PubMed Abstract | Publisher Full Text | Free Full Text 47. Tieu J, Shepherd E, Middleton P, et al. : Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes. Cochrane Database Syst Rev. Cochrane Library, 2017; 8 (8): CD010211. PubMed Abstract | Publisher Full Text | Free Full Text 48. Ohene-Agyei P, Iqbal A, Harding JE, et al. : Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024; 24 (1): 720. PubMed Abstract | Publisher Full Text | Free Full Text 49. Fiskå BS, Pay ASD, Staff AC, et al. : Gestational Diabetes Mellitus, follow-up of future maternal risk of cardiovascular disease and the use of eHealth technologies—a scoping review. Syst Rev. 2023; 12 (1): 178. PubMed Abstract | Publisher Full Text | Free Full Text 50. Hod M, Kapur A, Sacks DA, et al. : The International Federation of Gynecology and Obstetrics (FIGO) initiative on Gestational Diabetes Mellitus: a pragmatic guide for diagnosis, management, and care. Int J Gynecol Obstet. 2015; 131 Suppl (S3): S173–211. PubMed Abstract | Publisher Full Text 51. Diabetes Canada Clinical Practice Guidelines Expert CommitteeFeig DS, Berger H, et al. : Diabetes and pregnancy. Can J Diabetes. 2018; 42 Suppl 1 : S255–S282. PubMed Abstract | Publisher Full Text 52. American Diabetes Association Professional Practice Committee: 15. Management of diabetes in pregnancy: Standards of Care in Diabetes- 2024 . Diabetes Care. 2024; 47 (Suppl 1): S282–S294. PubMed Abstract | Publisher Full Text | Free Full Text 53. Smirnakis KV, Chasan-Taber L, Wolf M, et al. : Postpartum diabetes screening in women with a history of gestational diabetes. Obstet Gynecol. 2005; 106 (6): 1297–303. PubMed Abstract | Publisher Full Text 54. Bernstein JA, Quinn E, Ameli O, et al. : Follow-up after gestational diabetes: a fixable gap in women’s preventive healthcare. BMJ Open Diabetes Res Care. 2017; 5 (1): e000445. PubMed Abstract | Publisher Full Text | Free Full Text 55. Chittleborough CR, Baldock KL, Taylor AW, et al. : Long-term follow-up of women with Gestational Diabetes Mellitus: the South Australian Gestational Diabetes Mellitus Recall Register. Aust N Z J Obstet Gynaecol. 2010; 50 (2): 127–31. PubMed Abstract | Publisher Full Text 56. Wilkinson SA, Lim SS, Upham S, et al. : Who’s responsible for the care of women during and after a pregnancy affected by gestational diabetes? Med J Aust. 2014; 201 (3 Suppl): S78–81. PubMed Abstract | Publisher Full Text 57. Valabhji J, Barron E, Bradley D, et al. : Early outcomes from the English National Health Service Diabetes Prevention Programme. Diabetes Care. 2020; 43 (1): 152–60. PubMed Abstract | Publisher Full Text | Free Full Text 58. Dennison RA, Ward RJ, Griffin SJ, et al. : Women’s views on lifestyle changes to reduce the risk of developing type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice. Diabet Med. 2019; 36 (6): 702–17. PubMed Abstract | Publisher Full Text | Free Full Text 59. Keely E, Clark H, Karovitch A, et al. : Screening for type 2 diabetes following gestational diabetes. Can Fam Physician. 2010; 56 (6): 558–63. PubMed Abstract | Free Full Text 60. Ehrenthal DB, Maiden K, Rogers S, et al. : Postpartum healthcare after gestational diabetes and hypertension. J Womens Health (Larchmt). 2014; 23 (9): 760–4. PubMed Abstract | Publisher Full Text | Free Full Text 61. Lithgow GE, Rossi J, Griffin SJ, et al. : Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views. Br J Gen Pract. 2021; 71 (707): e473–e482. PubMed Abstract | Publisher Full Text | Free Full Text 62. Shea AK, Shah BR, Clark HD, et al. : The effectiveness of implementing a reminder system into routine clinical practice: does it increase postpartum screening in women with gestational diabetes? Chronic Dis Can. 2011; 31 (2): 58–64. PubMed Abstract | Publisher Full Text 63. Arksey H, O’Malley L: Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005; 8 (1): 19–32. Publisher Full Text 64. Peters MD, Godfrey C, McInerney P, et al. : Scoping reviews. In: Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, editors. JBI Manual for Evidence Synthesis . JBI, 2024. Publisher Full Text 65. Shamseer L, Moher D, Clarke M, et al. : Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015; 350 : g7647. PubMed Abstract | Publisher Full Text 66. Li-zhen L, Yun X, Xiao-Dong Z, et al. : Evaluation of guidelines on the screening and diagnosis of Gestational Diabetes Mellitus: systematic review. BMJ Open. 2019; 9 (5): e023014. PubMed Abstract | Publisher Full Text | Free Full Text 67. Definition of General Practice/Family Medicine. WONCA Europe. [cited 2024 Sep 9]. Reference Source 68. Jackson JL, Kuriyama A, Anton A, et al. : The accuracy of Google Translate for abstracting data from non-English-language trials for systematic reviews. Ann Intern Med. 2019; 171 (9): 677–679. PubMed Abstract | Publisher Full Text 69. Popel M, Tomkova M, Tomek J, et al. : Transforming machine translation: a deep learning system reaches news translation quality comparable to human professionals. Nat Commun. 2020; 11 (1): 4381. PubMed Abstract | Publisher Full Text | Free Full Text 70. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. : Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358 (19): 1991–2002. PubMed Abstract | Publisher Full Text 71. Tricco AC, Lillie E, Zarin W, et al. : PRISMA extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018; 169 (7): 467–473. PubMed Abstract | Publisher Full Text 72. Levac D, Colquhoun H, O’Brien KK: Scoping studies: advancing the methodology. Implement Sci. 2010; 5 : 69. PubMed Abstract | Publisher Full Text | Free Full Text 73. Tugwell P, Petticrew M, Robinson V, et al. : Cochrane and Campbell Collaborations, and health equity. Lancet. 2006; 367 (9517): 1128–30. PubMed Abstract | Publisher Full Text 74. O’Neill J, Tabish H, Welch V, et al. : Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol. 2014; 67 (1): 56–64. PubMed Abstract | Publisher Full Text 75. Petticrew M, Whitehead M, Macintyre SJ, et al. : Evidence for public health policy on inequalities: 1: the reality according to policymakers. J Epidemiol Community Health. 2004; 58 (10): 811–6. PubMed Abstract | Publisher Full Text | Free Full Text 76. Hoffmann TC, Glasziou PP, Boutron I, et al. : Better reporting of interventions: Template for Intervention Description and Replication (TIDieR) checklist and guide. BMJ. 2014; 348 : g1687. PubMed Abstract | Publisher Full Text 77. Wu N, O’Reilly S, Nielsen KK, et al. : Core outcome set for diabetes after pregnancy prevention across the life span: international Delphi study. BMJ Open Diabetes Res Care. 2020; 8 (2): e001594. PubMed Abstract | Publisher Full Text | Free Full Text 78. Bogdanet D, Reddin C, Macken E, et al. : Follow-up at 1 year and beyond of women with Gestational Diabetes treated with insulin and/or oral glucose-lowering agents: a core outcome set using a Delphi survey. Diabetologia. 2019; 62 (11): 2007–2016. PubMed Abstract | Publisher Full Text | Free Full Text 79. Pope C, Ziebland S, Mays N: Analysing qualitative data. BMJ. 2000; 320 (7227): 114–116. PubMed Abstract | Publisher Full Text | Free Full Text 80. Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In: Bryman A, Burgess RG, editors. Analyzing qualitative data. Abingdon, UK: Taylor & Francis, 1994; 173–94. Reference Source 81. Carroll C, Booth A, Leaviss J, et al. : “Best fit” framework synthesis: refining the method. BMC Med Res Methodol. 2013; 13 (1): 37. PubMed Abstract | Publisher Full Text | Free Full Text 82. Carroll C, Booth A, Cooper K: A worked example of ‘best fit’ framework synthesis: a systematic review of views concerning the taking of some potential chemopreventive agents. BMC Med Res Methodol. 2011; 11 (1): 29. PubMed Abstract | Publisher Full Text | Free Full Text 83. Wagner EH: Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998; 1 (1): 2–4. PubMed Abstract 84. Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness. JAMA. 2002; 288 (14): 1775–9. PubMed Abstract | Publisher Full Text 85. Bodenheimer T, Wagner EH, Grumbach K: Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002; 288 (15): 1909–14. PubMed Abstract | Publisher Full Text 86. Tsai AC, Morton SC, Mangione CM, et al. : A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care. 2005; 11 (8): 478–88. PubMed Abstract | Free Full Text 87. Vargas RB, Mangione CM, Asch S, et al. : Can a chronic care model collaborative reduce heart disease risk in patients with diabetes? J Gen Intern Med. 2007; 22 (2): 215–22. PubMed Abstract | Publisher Full Text | Free Full Text 88. Davy C, Bleasel J, Liu H, et al. : Effectiveness of chronic care models: opportunities for improving healthcare practice and health outcomes: a systematic review. BMC Health Serv Res. 2015; 15 : 194. PubMed Abstract | Publisher Full Text | Free Full Text 89. Goh LH, Siah CJR, Tam WWS, et al. : Effectiveness of the chronic care model for adults with type 2 diabetes in primary care: a systematic review and meta-analysis. Syst Rev. 2022; 11 (1): 273. PubMed Abstract | Publisher Full Text | Free Full Text 90. American Diabetes Association Professional Practice Committee: 1. Improving care and promoting health in populations: standards of medical care in diabetes— 2022. Diabetes Care. 2022; 45 (Supplement_ 1): S8–16. PubMed Abstract | Publisher Full Text 91. Miles MB, Huberman AM: Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks: Sage Publications, 1994; 338. Reference Source 92. Wong EC, Maher AR, Motala A, et al. : Methods for identifying health research gaps, needs, and priorities: a scoping review. J Gen Intern Med. 2022; 37 (1): 198–205. PubMed Abstract | Publisher Full Text | Free Full Text 93. Robinson KA, Saldanha IJ, McKoy NA: Development of a framework to identify research gaps from systematic reviews. J Clin Epidemiol. 2011; 64 (12): 1325–30. PubMed Abstract | Publisher Full Text 94. Saldanha IJ, Wilson LM, Bennett WL, et al. : Development and pilot test of a process to identify research needs from a systematic review. J Clin Epidemiol. 2013; 66 (5): 538–45. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 11 Feb 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of General Practice, University College Cork School of Medicine, Cork, T12 XF62, Ireland 2 The Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia 3 School of Nursing and Midwifery, University College Cork, Cork, T12 XF62, Ireland 4 School of Public Health, University College Cork, Cork, T12 XF62, Ireland 5 School of Medicine, College of Nursing, Midwifery and Health Science, University of Galway, Galway, H91 TK33, Ireland 6 Diabetes Collaborative Clinical Trial Network, University of Galway, Galway, H91 TK33, Ireland James O'Flynn Roles: Conceptualization, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Rita McMorrow Roles: Methodology, Writing – Review & Editing Tony Foley Roles: Conceptualization, Methodology, Writing – Review & Editing Rita Forde Roles: Methodology, Writing – Review & Editing Sheena McHugh Roles: Methodology, Writing – Review & Editing Christine Newman Roles: Methodology, Writing – Review & Editing Aisling A. Jennings Roles: Conceptualization, Funding Acquisition, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This scoping review is funded by the Irish College of General Practitioners (ICGP) Post-CSCST Fellowship in Gestational Diabetes. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 10 Apr 2025, 8:31 https://doi.org/10.12688/hrbopenres.14022.2 version 1 Published: 11 Feb 2025, 8:31 https://doi.org/10.12688/hrbopenres.14022.1 Copyright © 2025 O'Flynn J et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article O'Flynn J, McMorrow R, Foley T et al. The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.12688/hrbopenres.14022.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 10 Apr 2025 Revised Views 0 Cite How to cite this report: Goyal A. Reviewer Report For: The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.21956/hrbopenres.15532.r46733 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-31/v2#referee-response-46733 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 Apr 2025 Alpesh Goyal , Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15532.r46733 Thanks for revising the manuscript in line with the reviewer suggestions. The changes incorporated ... Continue reading READ ALL Thanks for revising the manuscript in line with the reviewer suggestions. The changes incorporated are appropriate and improve the quality of this paper. I have no further comments. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Diabetes in Pregnancy and Adrenal disorders I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Goyal A. Reviewer Report For: The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.21956/hrbopenres.15532.r46733 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-31/v2#referee-response-46733 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 11 Feb 2025 Views 0 Cite How to cite this report: Goyal A. Reviewer Report For: The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.21956/hrbopenres.15392.r46023 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-31/v1#referee-response-46023 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Mar 2025 Alpesh Goyal , Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15392.r46023 Thanks for the opportunity to review. The authors aim to perform a scoping review about long-term care of women with GDM in healthcare practices and the research gaps therein. The authors present a protocol for this review, which is fairly ... Continue reading READ ALL Thanks for the opportunity to review. The authors aim to perform a scoping review about long-term care of women with GDM in healthcare practices and the research gaps therein. The authors present a protocol for this review, which is fairly well written. I have the following comments/suggestions: 1. Background para 2: there are updated studies that highlight the link between GDM and steatosis and may be referred to (Kubihal S, et al., 2021 [Ref 1] and Foo RX, et al., 2024 [Ref 2]). 2. Background para 3: Authors state that lifestyle interventions are efficacious to prevent T2DM after GDM. However, I would like to draw their attention to the most updated meta-analysis on efficacy of interventions to prevent T2DM after GDM by Lee et al (Journal of Diabetes 2024; Lee VY, et al., 2024 [Ref 3]). This MA reported equivocal efficacy, and highlighted the need for more pharmacology trials in this field. Thus, the evidence, at this time, is equivocal and more research is needed, especially the role of pharmacological interventions. The MA by Lee et al focused on individuals with GDM complicated pregnancy within 5 years postpartum, and hence excluded the DPP GDM subgroup (mean 656 weeks postpartum). Please account for these recent updates in your description. 3. I agree that the postpartum screening rates are quite dismal and reported at <50% in most studies (Keely E 2024 [Ref 4], Goyal A, et al., 2018 [Ref 5].) Is that also a thrust area for your scoping review? 4. What time window will be used to define "long-term postpartum follow-up" or "beyond initial postpartum screening"?. In many settings, the initial postpartum screen may not happen at 6-12 weeks and be delayed for years. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable References 1. Kubihal S, Gupta Y, Shalimar, Kandasamy D, et al.: Prevalence of non-alcoholic fatty liver disease and factors associated with it in Indian women with a history of gestational diabetes mellitus. J Diabetes Investig . 2021; 12 (5): 877-885 PubMed Abstract | Publisher Full Text 2. Foo RX, Ma JJ, Du R, Goh GBB, et al.: Gestational diabetes mellitus and development of intergenerational non-alcoholic fatty liver disease (NAFLD) after delivery: a systematic review and meta-analysis. EClinicalMedicine . 2024; 72 : 102609 PubMed Abstract | Publisher Full Text 3. Lee VY, Monjur MR, Santos JA, Patel A, et al.: The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus-A living systematic review and meta-analysis. J Diabetes . 2024; 16 (8): e13590 PubMed Abstract | Publisher Full Text 4. Keely E: An opportunity not to be missed--how do we improve postpartum screening rates for women with gestational diabetes?. Diabetes Metab Res Rev . 2012; 28 (4): 312-6 PubMed Abstract | Publisher Full Text 5. Goyal A, Gupta Y, Kalaivani M, Sankar MJ, et al.: Long term (>1 year) postpartum glucose tolerance status among Indian women with history of Gestational Diabetes Mellitus (GDM) diagnosed by IADPSG criteria. Diabetes Res Clin Pract . 2018; 142 : 154-161 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Diabetes in Pregnancy and Adrenal disorders I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Goyal A. Reviewer Report For: The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.21956/hrbopenres.15392.r46023 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-31/v1#referee-response-46023 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Apr 2025 James O'Flynn , Department of General Practice, University College Cork School of Medicine, Cork, T12 XF62, Ireland 10 Apr 2025 Author Response We are most grateful to the reviewer for this detailed contribution. We have submitted an updated version of the protocol that takes into consideration the points made by the reviewer, ... Continue reading We are most grateful to the reviewer for this detailed contribution. We have submitted an updated version of the protocol that takes into consideration the points made by the reviewer, and which we feel is stronger as a result. We would like to take the opportunity to submit some more specific responses to the points made by the reviewer here: The link between hepatic steatosis Thank you for signposting towards these updated studies. We have swapped in the larger and more recent of your two suggestions (the review by Foo and colleagues). The efficacy of lifestyle interventions in preventing Type 2 Diabetes after GDM (Background, paragraph 3) Thank you for this comment. Indeed, statistical significance of the effects of lifestyle and pharmacological interventions on the incidence of type 2 diabetes and other outcome measures is inconsistent across the literature. The analysis you cite may raise the possibility of intervention and outcome timing as important factors. We have edited the text to emphasise the statistical limitations of the current literature on the subject: "A recent meta-analysis found that the hazard ratio of type 2 diabetes was significantly improved by interventions, while the relative risk did not achieve significance.1 This may occur if the effect of interventions is time-dependent, and may suggest that their effect may more readily delay than outright prevent the onset of type 2 diabetes." Thank you. Postpartum Screening as a thrust area for the review Thank you for this comment. Indeed the rates are disappointing and this is indeed a key reason why we are performing this research. We have re-emphasised this in the last paragraph of the introduction: "Therefore, a comprehensive understanding of long-term general practice healthcare for women with a history of GDM is required if the rates and quality of follow-up are to be improved ." The time window for "long-term postpartum follow-up" Thank you for raising this point. We had considered defining a strict minimum time frame for inclusion, and ultimately decided that a more flexible definition would be appropriate. We agree with your point that there is variability in the occurrence of that initial test, with the recommendations for the initial follow-up screening to be between 4 weeks at the earliest, to 6 months in some guidelines, and sometimes substantially longer in practicality.2 In addition, some study types (for example, qualitative studies of women’s experiences of healthcare) may explore a continuous timeframe from antenatal to years later. Because of these factors, a strict time-frame may impair the selection of some highly relevant papers. Authors’ judgments will be used to interpret whether candidate papers focus only on the initial postpartum period or contain data looking beyond that. To reduce confusion, we have clarified the text to state that we want to explore research that explores beyond the early post-partum “period” rather than healthcare after initial “screening”. Thank you. The review provided valuable opportunities to improve the accuracy and clarity of the protocol, and we feel that the newly submitted version has benefitted from these changes. Thank you. References: 1. Lee VY, Monjur MR, Santos JA, Patel A, Liu R, Di Tanna GL, et al. The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus—A living systematic review and meta-analysis. J Diabetes. 2024;16(8):e13590. 2. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. We are most grateful to the reviewer for this detailed contribution. We have submitted an updated version of the protocol that takes into consideration the points made by the reviewer, and which we feel is stronger as a result. We would like to take the opportunity to submit some more specific responses to the points made by the reviewer here: The link between hepatic steatosis Thank you for signposting towards these updated studies. We have swapped in the larger and more recent of your two suggestions (the review by Foo and colleagues). The efficacy of lifestyle interventions in preventing Type 2 Diabetes after GDM (Background, paragraph 3) Thank you for this comment. Indeed, statistical significance of the effects of lifestyle and pharmacological interventions on the incidence of type 2 diabetes and other outcome measures is inconsistent across the literature. The analysis you cite may raise the possibility of intervention and outcome timing as important factors. We have edited the text to emphasise the statistical limitations of the current literature on the subject: "A recent meta-analysis found that the hazard ratio of type 2 diabetes was significantly improved by interventions, while the relative risk did not achieve significance.1 This may occur if the effect of interventions is time-dependent, and may suggest that their effect may more readily delay than outright prevent the onset of type 2 diabetes." Thank you. Postpartum Screening as a thrust area for the review Thank you for this comment. Indeed the rates are disappointing and this is indeed a key reason why we are performing this research. We have re-emphasised this in the last paragraph of the introduction: "Therefore, a comprehensive understanding of long-term general practice healthcare for women with a history of GDM is required if the rates and quality of follow-up are to be improved ." The time window for "long-term postpartum follow-up" Thank you for raising this point. We had considered defining a strict minimum time frame for inclusion, and ultimately decided that a more flexible definition would be appropriate. We agree with your point that there is variability in the occurrence of that initial test, with the recommendations for the initial follow-up screening to be between 4 weeks at the earliest, to 6 months in some guidelines, and sometimes substantially longer in practicality.2 In addition, some study types (for example, qualitative studies of women’s experiences of healthcare) may explore a continuous timeframe from antenatal to years later. Because of these factors, a strict time-frame may impair the selection of some highly relevant papers. Authors’ judgments will be used to interpret whether candidate papers focus only on the initial postpartum period or contain data looking beyond that. To reduce confusion, we have clarified the text to state that we want to explore research that explores beyond the early post-partum “period” rather than healthcare after initial “screening”. Thank you. The review provided valuable opportunities to improve the accuracy and clarity of the protocol, and we feel that the newly submitted version has benefitted from these changes. Thank you. References: 1. Lee VY, Monjur MR, Santos JA, Patel A, Liu R, Di Tanna GL, et al. The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus—A living systematic review and meta-analysis. J Diabetes. 2024;16(8):e13590. 2. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Apr 2025 James O'Flynn , Department of General Practice, University College Cork School of Medicine, Cork, T12 XF62, Ireland 10 Apr 2025 Author Response We are most grateful to the reviewer for this detailed contribution. We have submitted an updated version of the protocol that takes into consideration the points made by the reviewer, ... Continue reading We are most grateful to the reviewer for this detailed contribution. We have submitted an updated version of the protocol that takes into consideration the points made by the reviewer, and which we feel is stronger as a result. We would like to take the opportunity to submit some more specific responses to the points made by the reviewer here: The link between hepatic steatosis Thank you for signposting towards these updated studies. We have swapped in the larger and more recent of your two suggestions (the review by Foo and colleagues). The efficacy of lifestyle interventions in preventing Type 2 Diabetes after GDM (Background, paragraph 3) Thank you for this comment. Indeed, statistical significance of the effects of lifestyle and pharmacological interventions on the incidence of type 2 diabetes and other outcome measures is inconsistent across the literature. The analysis you cite may raise the possibility of intervention and outcome timing as important factors. We have edited the text to emphasise the statistical limitations of the current literature on the subject: "A recent meta-analysis found that the hazard ratio of type 2 diabetes was significantly improved by interventions, while the relative risk did not achieve significance.1 This may occur if the effect of interventions is time-dependent, and may suggest that their effect may more readily delay than outright prevent the onset of type 2 diabetes." Thank you. Postpartum Screening as a thrust area for the review Thank you for this comment. Indeed the rates are disappointing and this is indeed a key reason why we are performing this research. We have re-emphasised this in the last paragraph of the introduction: "Therefore, a comprehensive understanding of long-term general practice healthcare for women with a history of GDM is required if the rates and quality of follow-up are to be improved ." The time window for "long-term postpartum follow-up" Thank you for raising this point. We had considered defining a strict minimum time frame for inclusion, and ultimately decided that a more flexible definition would be appropriate. We agree with your point that there is variability in the occurrence of that initial test, with the recommendations for the initial follow-up screening to be between 4 weeks at the earliest, to 6 months in some guidelines, and sometimes substantially longer in practicality.2 In addition, some study types (for example, qualitative studies of women’s experiences of healthcare) may explore a continuous timeframe from antenatal to years later. Because of these factors, a strict time-frame may impair the selection of some highly relevant papers. Authors’ judgments will be used to interpret whether candidate papers focus only on the initial postpartum period or contain data looking beyond that. To reduce confusion, we have clarified the text to state that we want to explore research that explores beyond the early post-partum “period” rather than healthcare after initial “screening”. Thank you. The review provided valuable opportunities to improve the accuracy and clarity of the protocol, and we feel that the newly submitted version has benefitted from these changes. Thank you. References: 1. Lee VY, Monjur MR, Santos JA, Patel A, Liu R, Di Tanna GL, et al. The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus—A living systematic review and meta-analysis. J Diabetes. 2024;16(8):e13590. 2. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. We are most grateful to the reviewer for this detailed contribution. We have submitted an updated version of the protocol that takes into consideration the points made by the reviewer, and which we feel is stronger as a result. We would like to take the opportunity to submit some more specific responses to the points made by the reviewer here: The link between hepatic steatosis Thank you for signposting towards these updated studies. We have swapped in the larger and more recent of your two suggestions (the review by Foo and colleagues). The efficacy of lifestyle interventions in preventing Type 2 Diabetes after GDM (Background, paragraph 3) Thank you for this comment. Indeed, statistical significance of the effects of lifestyle and pharmacological interventions on the incidence of type 2 diabetes and other outcome measures is inconsistent across the literature. The analysis you cite may raise the possibility of intervention and outcome timing as important factors. We have edited the text to emphasise the statistical limitations of the current literature on the subject: "A recent meta-analysis found that the hazard ratio of type 2 diabetes was significantly improved by interventions, while the relative risk did not achieve significance.1 This may occur if the effect of interventions is time-dependent, and may suggest that their effect may more readily delay than outright prevent the onset of type 2 diabetes." Thank you. Postpartum Screening as a thrust area for the review Thank you for this comment. Indeed the rates are disappointing and this is indeed a key reason why we are performing this research. We have re-emphasised this in the last paragraph of the introduction: "Therefore, a comprehensive understanding of long-term general practice healthcare for women with a history of GDM is required if the rates and quality of follow-up are to be improved ." The time window for "long-term postpartum follow-up" Thank you for raising this point. We had considered defining a strict minimum time frame for inclusion, and ultimately decided that a more flexible definition would be appropriate. We agree with your point that there is variability in the occurrence of that initial test, with the recommendations for the initial follow-up screening to be between 4 weeks at the earliest, to 6 months in some guidelines, and sometimes substantially longer in practicality.2 In addition, some study types (for example, qualitative studies of women’s experiences of healthcare) may explore a continuous timeframe from antenatal to years later. Because of these factors, a strict time-frame may impair the selection of some highly relevant papers. Authors’ judgments will be used to interpret whether candidate papers focus only on the initial postpartum period or contain data looking beyond that. To reduce confusion, we have clarified the text to state that we want to explore research that explores beyond the early post-partum “period” rather than healthcare after initial “screening”. Thank you. The review provided valuable opportunities to improve the accuracy and clarity of the protocol, and we feel that the newly submitted version has benefitted from these changes. Thank you. References: 1. Lee VY, Monjur MR, Santos JA, Patel A, Liu R, Di Tanna GL, et al. The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus—A living systematic review and meta-analysis. J Diabetes. 2024;16(8):e13590. 2. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Flynn A. Reviewer Report For: The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.21956/hrbopenres.15392.r45820 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-31/v1#referee-response-45820 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 06 Mar 2025 Angela Flynn , Royal College of Surgeons in Ireland, Dublin, Ireland Approved VIEWS 0 https://doi.org/10.21956/hrbopenres.15392.r45820 Overall, this scoping review protocol is very well written, and focuses on the important topic of optimising health and reducing the risk of chronic disease in women with previous GDM. The protocol outlines the methodology that will be undertaken to ... Continue reading READ ALL Overall, this scoping review protocol is very well written, and focuses on the important topic of optimising health and reducing the risk of chronic disease in women with previous GDM. The protocol outlines the methodology that will be undertaken to map the existing research evidence on longterm GP based healthcare for women with previous GDM. My major comment is increasing the clarity of the ‘concept’ of the scoping review. It needs to be clear that this review is mapping the research evidence and is not a review of current healthcare practices. The concept in Table 1 needs to reflect this as the currently stated ‘characteristics of healthcare’ does not suggest a research focus. Ensure it is clear throughout the article that the review is mapping research evidence related to the longterm care of women with previous GDM and is not evaluating health services. Other comments: It is not clear from the background what is meant by ‘longterm care’. What do the authors mean by ‘longterm healthcare’ for women with previous GDM? It is worth noting in the background although primary care has been identified as an appropriate setting for longterm follow up, there are also several prevention programmes rolled out internationally to prevent the risk of chronic disease in women with previous GDM. Diabetes prevention programmes exist in several countries and are delivered virtually, either through self referral or referral through primary care. GPs have a role to ensure women can access existing programmes. The background is focused on prevention of chronic disease, however, the concept also focuses on prevention of GDM recurrence. Optimising preconception health in women with previous GDM is part of longterm care but is not mentioned in the background. There are multiple research papers on preconception care and how preconception care can be implemented in primary care; Schoenaker D, et al., 2024 (Ref 1) and Schoenaker D, et al., 2022 (Ref 2) Due to the nature of the research, the authors should include adding in a grey literature search. It might be useful to identify educational interventions in primary care settings. Agree with ensuring the search strategy is relevant, however, what is the rationale for the search being limited to the last 10 years? Please add in. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable References 1. Schoenaker D, Lovegrove E, Santer M, Matvienko-Sikar K, et al.: Developing consensus on priorities for preconception care in the general practice setting in the UK: Study protocol. PLoS One . 2024; 19 (11): e0311578 PubMed Abstract | Publisher Full Text 2. Schoenaker D, Connolly A, Stephenson J: Preconception care in primary care: supporting patients to have healthier pregnancies and babies. Br J Gen Pract . 2022; 72 (717): 152 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Maternal health research, in particular preconception, pregnancy, and postpartum research of women at high metabolic risk eg women living with obesity or those who develop diabetes in pregnancy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Flynn A. Reviewer Report For: The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.21956/hrbopenres.15392.r45820 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-31/v1#referee-response-45820 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 10 Apr 2025 James O'Flynn , Department of General Practice, University College Cork School of Medicine, Cork, T12 XF62, Ireland 10 Apr 2025 Author Response We are very thankful for this peer review. We have considered the feedback and submitted an updated version of the protocol. We would like to take this opportunity to more ... Continue reading We are very thankful for this peer review. We have considered the feedback and submitted an updated version of the protocol. We would like to take this opportunity to more directly respond to the points made by the reviewer: Mapping Evidence rather than evaluating health services Thank you for raising this point. We have made adjustments emphasising that our focus is to review the research rather than to evaluate health services. These changes occur in the Objectives, in Table 1, in the first line of the Concept paragraph, in the Discussion and in the Conclusion. Thank you. The meaning of "Long term care" Thank you for identifying this opportunity to improve the clarity of this concept. We have edited the fourth paragraph of the introduction to say that “this may include lifelong regular screening for early diagnosis of diabetes or cardiovascular disease, and ongoing support for maintenance of positive health behaviours”. We would hope that this gives clarity on the timeframe and the broad content of this care. Prevention programmes including DPP Thank you. We agree with your suggestion that such programmes are sufficiently important to necessitate their inclusion in this protocol, and have now done so in the introduction: "GPs can provide direct support and can connect women with parallel services, including Diabetes Prevention Programmes."1,2 However, a detailed discussion of diabetes prevention programmes is omitted in this general-practice focused review. The importance of preventing GDM recurrence Thank you for this comment. We agree that the protocol may benefit from emphasis on this important risk for these women. We have included a point on this within the introduction: "Data regarding the role for preconception care aimed at reducing the risk of GDM recurrence are also lacking.3,4,5. In spite of this, clinical practice guidelines frequently identify the importance of family planning and contraception for women with a history of GDM.6" Thank you. Grey Literature Thank you for raising this point. Grey literature may contain valuable sources, and, as you point out, may be particularly valuable for identifying educational interventions. However, the primary aim for this scoping review will be to synthesise empirical evidence from peer-reviewed publications. In the absence of an assessment of quality within a scoping review, this creates some standardisation of quality across the included studies. Furthermore, given the scope of the subject area, including grey literature would significantly expand the search and screening process, which may compromise the feasibility of this review. To improve the clarity of our protocol, we have stated our intention to omit grey literature more explicitly. Thank you. 10 year eligibility limit Thank you for this comment. Rationale clarified within the text: "To accommodate the rapidly evolving healthcare landscape, and to permit permeation of the practice-changing findings of the Hyperglycemia and Adverse Pregnancy Outcomes study 2008, the search years will be limited to the past 10 years (2014 or later)"7 Again, we are most grateful for your review, which identifies a number of opportunities to strengthen this protocol. Thank you. References: 1. Valabhji J, Barron E, Bradley D, Bakhai C, Fagg J, O’Neill S, et al. Early Outcomes From the English National Health Service Diabetes Prevention Programme. Diabetes Care. 2019 Dec 12;43(1):152–60. 2. Dennison RA, Ward RJ, Griffin SJ, Usher‐Smith JA. Women’s views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice. Diabet Med. 2019 Jun;36(6):702–17. 3. Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, et al. Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of gestational diabetes mellitus. Am J Obstet Gynecol. 2023 Aug 1;229(2):158.e1-158.e14. 4. Quotah OF, Andreeva D, Nowak KG, Dalrymple KV, Almubarak A, Patel A, et al. Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials. Diabetol Metab Syndr. 2024 Jan 4;16:8. 5. Tieu J, Shepherd E, Middleton P, Crowther CA. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes - Tieu, J - 2017 | Cochrane Library. [cited 2025 Mar 20]; Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010211.pub3/full?cookiesEnabled 6. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. 7. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8;358(19):1991–2002. We are very thankful for this peer review. We have considered the feedback and submitted an updated version of the protocol. We would like to take this opportunity to more directly respond to the points made by the reviewer: Mapping Evidence rather than evaluating health services Thank you for raising this point. We have made adjustments emphasising that our focus is to review the research rather than to evaluate health services. These changes occur in the Objectives, in Table 1, in the first line of the Concept paragraph, in the Discussion and in the Conclusion. Thank you. The meaning of "Long term care" Thank you for identifying this opportunity to improve the clarity of this concept. We have edited the fourth paragraph of the introduction to say that “this may include lifelong regular screening for early diagnosis of diabetes or cardiovascular disease, and ongoing support for maintenance of positive health behaviours”. We would hope that this gives clarity on the timeframe and the broad content of this care. Prevention programmes including DPP Thank you. We agree with your suggestion that such programmes are sufficiently important to necessitate their inclusion in this protocol, and have now done so in the introduction: "GPs can provide direct support and can connect women with parallel services, including Diabetes Prevention Programmes."1,2 However, a detailed discussion of diabetes prevention programmes is omitted in this general-practice focused review. The importance of preventing GDM recurrence Thank you for this comment. We agree that the protocol may benefit from emphasis on this important risk for these women. We have included a point on this within the introduction: "Data regarding the role for preconception care aimed at reducing the risk of GDM recurrence are also lacking.3,4,5. In spite of this, clinical practice guidelines frequently identify the importance of family planning and contraception for women with a history of GDM.6" Thank you. Grey Literature Thank you for raising this point. Grey literature may contain valuable sources, and, as you point out, may be particularly valuable for identifying educational interventions. However, the primary aim for this scoping review will be to synthesise empirical evidence from peer-reviewed publications. In the absence of an assessment of quality within a scoping review, this creates some standardisation of quality across the included studies. Furthermore, given the scope of the subject area, including grey literature would significantly expand the search and screening process, which may compromise the feasibility of this review. To improve the clarity of our protocol, we have stated our intention to omit grey literature more explicitly. Thank you. 10 year eligibility limit Thank you for this comment. Rationale clarified within the text: "To accommodate the rapidly evolving healthcare landscape, and to permit permeation of the practice-changing findings of the Hyperglycemia and Adverse Pregnancy Outcomes study 2008, the search years will be limited to the past 10 years (2014 or later)"7 Again, we are most grateful for your review, which identifies a number of opportunities to strengthen this protocol. Thank you. References: 1. Valabhji J, Barron E, Bradley D, Bakhai C, Fagg J, O’Neill S, et al. Early Outcomes From the English National Health Service Diabetes Prevention Programme. Diabetes Care. 2019 Dec 12;43(1):152–60. 2. Dennison RA, Ward RJ, Griffin SJ, Usher‐Smith JA. Women’s views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice. Diabet Med. 2019 Jun;36(6):702–17. 3. Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, et al. Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of gestational diabetes mellitus. Am J Obstet Gynecol. 2023 Aug 1;229(2):158.e1-158.e14. 4. Quotah OF, Andreeva D, Nowak KG, Dalrymple KV, Almubarak A, Patel A, et al. Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials. Diabetol Metab Syndr. 2024 Jan 4;16:8. 5. Tieu J, Shepherd E, Middleton P, Crowther CA. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes - Tieu, J - 2017 | Cochrane Library. [cited 2025 Mar 20]; Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010211.pub3/full?cookiesEnabled 6. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. 7. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8;358(19):1991–2002. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 10 Apr 2025 James O'Flynn , Department of General Practice, University College Cork School of Medicine, Cork, T12 XF62, Ireland 10 Apr 2025 Author Response We are very thankful for this peer review. We have considered the feedback and submitted an updated version of the protocol. We would like to take this opportunity to more ... Continue reading We are very thankful for this peer review. We have considered the feedback and submitted an updated version of the protocol. We would like to take this opportunity to more directly respond to the points made by the reviewer: Mapping Evidence rather than evaluating health services Thank you for raising this point. We have made adjustments emphasising that our focus is to review the research rather than to evaluate health services. These changes occur in the Objectives, in Table 1, in the first line of the Concept paragraph, in the Discussion and in the Conclusion. Thank you. The meaning of "Long term care" Thank you for identifying this opportunity to improve the clarity of this concept. We have edited the fourth paragraph of the introduction to say that “this may include lifelong regular screening for early diagnosis of diabetes or cardiovascular disease, and ongoing support for maintenance of positive health behaviours”. We would hope that this gives clarity on the timeframe and the broad content of this care. Prevention programmes including DPP Thank you. We agree with your suggestion that such programmes are sufficiently important to necessitate their inclusion in this protocol, and have now done so in the introduction: "GPs can provide direct support and can connect women with parallel services, including Diabetes Prevention Programmes."1,2 However, a detailed discussion of diabetes prevention programmes is omitted in this general-practice focused review. The importance of preventing GDM recurrence Thank you for this comment. We agree that the protocol may benefit from emphasis on this important risk for these women. We have included a point on this within the introduction: "Data regarding the role for preconception care aimed at reducing the risk of GDM recurrence are also lacking.3,4,5. In spite of this, clinical practice guidelines frequently identify the importance of family planning and contraception for women with a history of GDM.6" Thank you. Grey Literature Thank you for raising this point. Grey literature may contain valuable sources, and, as you point out, may be particularly valuable for identifying educational interventions. However, the primary aim for this scoping review will be to synthesise empirical evidence from peer-reviewed publications. In the absence of an assessment of quality within a scoping review, this creates some standardisation of quality across the included studies. Furthermore, given the scope of the subject area, including grey literature would significantly expand the search and screening process, which may compromise the feasibility of this review. To improve the clarity of our protocol, we have stated our intention to omit grey literature more explicitly. Thank you. 10 year eligibility limit Thank you for this comment. Rationale clarified within the text: "To accommodate the rapidly evolving healthcare landscape, and to permit permeation of the practice-changing findings of the Hyperglycemia and Adverse Pregnancy Outcomes study 2008, the search years will be limited to the past 10 years (2014 or later)"7 Again, we are most grateful for your review, which identifies a number of opportunities to strengthen this protocol. Thank you. References: 1. Valabhji J, Barron E, Bradley D, Bakhai C, Fagg J, O’Neill S, et al. Early Outcomes From the English National Health Service Diabetes Prevention Programme. Diabetes Care. 2019 Dec 12;43(1):152–60. 2. Dennison RA, Ward RJ, Griffin SJ, Usher‐Smith JA. Women’s views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice. Diabet Med. 2019 Jun;36(6):702–17. 3. Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, et al. Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of gestational diabetes mellitus. Am J Obstet Gynecol. 2023 Aug 1;229(2):158.e1-158.e14. 4. Quotah OF, Andreeva D, Nowak KG, Dalrymple KV, Almubarak A, Patel A, et al. Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials. Diabetol Metab Syndr. 2024 Jan 4;16:8. 5. Tieu J, Shepherd E, Middleton P, Crowther CA. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes - Tieu, J - 2017 | Cochrane Library. [cited 2025 Mar 20]; Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010211.pub3/full?cookiesEnabled 6. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. 7. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8;358(19):1991–2002. We are very thankful for this peer review. We have considered the feedback and submitted an updated version of the protocol. We would like to take this opportunity to more directly respond to the points made by the reviewer: Mapping Evidence rather than evaluating health services Thank you for raising this point. We have made adjustments emphasising that our focus is to review the research rather than to evaluate health services. These changes occur in the Objectives, in Table 1, in the first line of the Concept paragraph, in the Discussion and in the Conclusion. Thank you. The meaning of "Long term care" Thank you for identifying this opportunity to improve the clarity of this concept. We have edited the fourth paragraph of the introduction to say that “this may include lifelong regular screening for early diagnosis of diabetes or cardiovascular disease, and ongoing support for maintenance of positive health behaviours”. We would hope that this gives clarity on the timeframe and the broad content of this care. Prevention programmes including DPP Thank you. We agree with your suggestion that such programmes are sufficiently important to necessitate their inclusion in this protocol, and have now done so in the introduction: "GPs can provide direct support and can connect women with parallel services, including Diabetes Prevention Programmes."1,2 However, a detailed discussion of diabetes prevention programmes is omitted in this general-practice focused review. The importance of preventing GDM recurrence Thank you for this comment. We agree that the protocol may benefit from emphasis on this important risk for these women. We have included a point on this within the introduction: "Data regarding the role for preconception care aimed at reducing the risk of GDM recurrence are also lacking.3,4,5. In spite of this, clinical practice guidelines frequently identify the importance of family planning and contraception for women with a history of GDM.6" Thank you. Grey Literature Thank you for raising this point. Grey literature may contain valuable sources, and, as you point out, may be particularly valuable for identifying educational interventions. However, the primary aim for this scoping review will be to synthesise empirical evidence from peer-reviewed publications. In the absence of an assessment of quality within a scoping review, this creates some standardisation of quality across the included studies. Furthermore, given the scope of the subject area, including grey literature would significantly expand the search and screening process, which may compromise the feasibility of this review. To improve the clarity of our protocol, we have stated our intention to omit grey literature more explicitly. Thank you. 10 year eligibility limit Thank you for this comment. Rationale clarified within the text: "To accommodate the rapidly evolving healthcare landscape, and to permit permeation of the practice-changing findings of the Hyperglycemia and Adverse Pregnancy Outcomes study 2008, the search years will be limited to the past 10 years (2014 or later)"7 Again, we are most grateful for your review, which identifies a number of opportunities to strengthen this protocol. Thank you. References: 1. Valabhji J, Barron E, Bradley D, Bakhai C, Fagg J, O’Neill S, et al. Early Outcomes From the English National Health Service Diabetes Prevention Programme. Diabetes Care. 2019 Dec 12;43(1):152–60. 2. Dennison RA, Ward RJ, Griffin SJ, Usher‐Smith JA. Women’s views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice. Diabet Med. 2019 Jun;36(6):702–17. 3. Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, et al. Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of gestational diabetes mellitus. Am J Obstet Gynecol. 2023 Aug 1;229(2):158.e1-158.e14. 4. Quotah OF, Andreeva D, Nowak KG, Dalrymple KV, Almubarak A, Patel A, et al. Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials. Diabetol Metab Syndr. 2024 Jan 4;16:8. 5. Tieu J, Shepherd E, Middleton P, Crowther CA. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes - Tieu, J - 2017 | Cochrane Library. [cited 2025 Mar 20]; Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010211.pub3/full?cookiesEnabled 6. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. 7. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8;358(19):1991–2002. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 11 Feb 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 10 Apr 25 read Version 1 11 Feb 25 read read Angela Flynn , Royal College of Surgeons in Ireland, Dublin, Ireland Alpesh Goyal , All India Institute of Medical Sciences, Bhopal, India Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Goyal A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 Apr 2025 | for Version 2 Alpesh Goyal , Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India 0 Views copyright © 2025 Goyal A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thanks for revising the manuscript in line with the reviewer suggestions. The changes incorporated are appropriate and improve the quality of this paper. I have no further comments. Competing Interests No competing interests were disclosed. Reviewer Expertise Diabetes in Pregnancy and Adrenal disorders I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Goyal A. Peer Review Report For: The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.21956/hrbopenres.15532.r46733) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-31/v2#referee-response-46733 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Goyal A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Mar 2025 | for Version 1 Alpesh Goyal , Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India 0 Views copyright © 2025 Goyal A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thanks for the opportunity to review. The authors aim to perform a scoping review about long-term care of women with GDM in healthcare practices and the research gaps therein. The authors present a protocol for this review, which is fairly well written. I have the following comments/suggestions: 1. Background para 2: there are updated studies that highlight the link between GDM and steatosis and may be referred to (Kubihal S, et al., 2021 [Ref 1] and Foo RX, et al., 2024 [Ref 2]). 2. Background para 3: Authors state that lifestyle interventions are efficacious to prevent T2DM after GDM. However, I would like to draw their attention to the most updated meta-analysis on efficacy of interventions to prevent T2DM after GDM by Lee et al (Journal of Diabetes 2024; Lee VY, et al., 2024 [Ref 3]). This MA reported equivocal efficacy, and highlighted the need for more pharmacology trials in this field. Thus, the evidence, at this time, is equivocal and more research is needed, especially the role of pharmacological interventions. The MA by Lee et al focused on individuals with GDM complicated pregnancy within 5 years postpartum, and hence excluded the DPP GDM subgroup (mean 656 weeks postpartum). Please account for these recent updates in your description. 3. I agree that the postpartum screening rates are quite dismal and reported at <50% in most studies (Keely E 2024 [Ref 4], Goyal A, et al., 2018 [Ref 5].) Is that also a thrust area for your scoping review? 4. What time window will be used to define "long-term postpartum follow-up" or "beyond initial postpartum screening"?. In many settings, the initial postpartum screen may not happen at 6-12 weeks and be delayed for years. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable References 1. Kubihal S, Gupta Y, Shalimar, Kandasamy D, et al.: Prevalence of non-alcoholic fatty liver disease and factors associated with it in Indian women with a history of gestational diabetes mellitus. J Diabetes Investig . 2021; 12 (5): 877-885 PubMed Abstract | Publisher Full Text 2. Foo RX, Ma JJ, Du R, Goh GBB, et al.: Gestational diabetes mellitus and development of intergenerational non-alcoholic fatty liver disease (NAFLD) after delivery: a systematic review and meta-analysis. EClinicalMedicine . 2024; 72 : 102609 PubMed Abstract | Publisher Full Text 3. Lee VY, Monjur MR, Santos JA, Patel A, et al.: The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus-A living systematic review and meta-analysis. J Diabetes . 2024; 16 (8): e13590 PubMed Abstract | Publisher Full Text 4. Keely E: An opportunity not to be missed--how do we improve postpartum screening rates for women with gestational diabetes?. Diabetes Metab Res Rev . 2012; 28 (4): 312-6 PubMed Abstract | Publisher Full Text 5. Goyal A, Gupta Y, Kalaivani M, Sankar MJ, et al.: Long term (>1 year) postpartum glucose tolerance status among Indian women with history of Gestational Diabetes Mellitus (GDM) diagnosed by IADPSG criteria. Diabetes Res Clin Pract . 2018; 142 : 154-161 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Diabetes in Pregnancy and Adrenal disorders I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 10 Apr 2025 James O'Flynn, Department of General Practice, University College Cork School of Medicine, Cork, T12 XF62, Ireland We are most grateful to the reviewer for this detailed contribution. We have submitted an updated version of the protocol that takes into consideration the points made by the reviewer, and which we feel is stronger as a result. We would like to take the opportunity to submit some more specific responses to the points made by the reviewer here: The link between hepatic steatosis Thank you for signposting towards these updated studies. We have swapped in the larger and more recent of your two suggestions (the review by Foo and colleagues). The efficacy of lifestyle interventions in preventing Type 2 Diabetes after GDM (Background, paragraph 3) Thank you for this comment. Indeed, statistical significance of the effects of lifestyle and pharmacological interventions on the incidence of type 2 diabetes and other outcome measures is inconsistent across the literature. The analysis you cite may raise the possibility of intervention and outcome timing as important factors. We have edited the text to emphasise the statistical limitations of the current literature on the subject: "A recent meta-analysis found that the hazard ratio of type 2 diabetes was significantly improved by interventions, while the relative risk did not achieve significance.1 This may occur if the effect of interventions is time-dependent, and may suggest that their effect may more readily delay than outright prevent the onset of type 2 diabetes." Thank you. Postpartum Screening as a thrust area for the review Thank you for this comment. Indeed the rates are disappointing and this is indeed a key reason why we are performing this research. We have re-emphasised this in the last paragraph of the introduction: "Therefore, a comprehensive understanding of long-term general practice healthcare for women with a history of GDM is required if the rates and quality of follow-up are to be improved ." The time window for "long-term postpartum follow-up" Thank you for raising this point. We had considered defining a strict minimum time frame for inclusion, and ultimately decided that a more flexible definition would be appropriate. We agree with your point that there is variability in the occurrence of that initial test, with the recommendations for the initial follow-up screening to be between 4 weeks at the earliest, to 6 months in some guidelines, and sometimes substantially longer in practicality.2 In addition, some study types (for example, qualitative studies of women’s experiences of healthcare) may explore a continuous timeframe from antenatal to years later. Because of these factors, a strict time-frame may impair the selection of some highly relevant papers. Authors’ judgments will be used to interpret whether candidate papers focus only on the initial postpartum period or contain data looking beyond that. To reduce confusion, we have clarified the text to state that we want to explore research that explores beyond the early post-partum “period” rather than healthcare after initial “screening”. Thank you. The review provided valuable opportunities to improve the accuracy and clarity of the protocol, and we feel that the newly submitted version has benefitted from these changes. Thank you. References: 1. Lee VY, Monjur MR, Santos JA, Patel A, Liu R, Di Tanna GL, et al. The efficacy of interventions to prevent type 2 diabetes among women with recent gestational diabetes mellitus—A living systematic review and meta-analysis. J Diabetes. 2024;16(8):e13590. 2. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Goyal A. Peer Review Report For: The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.21956/hrbopenres.15392.r46023) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-31/v1#referee-response-46023 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Flynn A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 Mar 2025 | for Version 1 Angela Flynn , Royal College of Surgeons in Ireland, Dublin, Ireland 0 Views copyright © 2025 Flynn A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Overall, this scoping review protocol is very well written, and focuses on the important topic of optimising health and reducing the risk of chronic disease in women with previous GDM. The protocol outlines the methodology that will be undertaken to map the existing research evidence on longterm GP based healthcare for women with previous GDM. My major comment is increasing the clarity of the ‘concept’ of the scoping review. It needs to be clear that this review is mapping the research evidence and is not a review of current healthcare practices. The concept in Table 1 needs to reflect this as the currently stated ‘characteristics of healthcare’ does not suggest a research focus. Ensure it is clear throughout the article that the review is mapping research evidence related to the longterm care of women with previous GDM and is not evaluating health services. Other comments: It is not clear from the background what is meant by ‘longterm care’. What do the authors mean by ‘longterm healthcare’ for women with previous GDM? It is worth noting in the background although primary care has been identified as an appropriate setting for longterm follow up, there are also several prevention programmes rolled out internationally to prevent the risk of chronic disease in women with previous GDM. Diabetes prevention programmes exist in several countries and are delivered virtually, either through self referral or referral through primary care. GPs have a role to ensure women can access existing programmes. The background is focused on prevention of chronic disease, however, the concept also focuses on prevention of GDM recurrence. Optimising preconception health in women with previous GDM is part of longterm care but is not mentioned in the background. There are multiple research papers on preconception care and how preconception care can be implemented in primary care; Schoenaker D, et al., 2024 (Ref 1) and Schoenaker D, et al., 2022 (Ref 2) Due to the nature of the research, the authors should include adding in a grey literature search. It might be useful to identify educational interventions in primary care settings. Agree with ensuring the search strategy is relevant, however, what is the rationale for the search being limited to the last 10 years? Please add in. Is the rationale for, and objectives of, the study clearly described? Yes Is the study design appropriate for the research question? Yes Are sufficient details of the methods provided to allow replication by others? Yes Are the datasets clearly presented in a useable and accessible format? Not applicable References 1. Schoenaker D, Lovegrove E, Santer M, Matvienko-Sikar K, et al.: Developing consensus on priorities for preconception care in the general practice setting in the UK: Study protocol. PLoS One . 2024; 19 (11): e0311578 PubMed Abstract | Publisher Full Text 2. Schoenaker D, Connolly A, Stephenson J: Preconception care in primary care: supporting patients to have healthier pregnancies and babies. Br J Gen Pract . 2022; 72 (717): 152 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Maternal health research, in particular preconception, pregnancy, and postpartum research of women at high metabolic risk eg women living with obesity or those who develop diabetes in pregnancy I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 10 Apr 2025 James O'Flynn, Department of General Practice, University College Cork School of Medicine, Cork, T12 XF62, Ireland We are very thankful for this peer review. We have considered the feedback and submitted an updated version of the protocol. We would like to take this opportunity to more directly respond to the points made by the reviewer: Mapping Evidence rather than evaluating health services Thank you for raising this point. We have made adjustments emphasising that our focus is to review the research rather than to evaluate health services. These changes occur in the Objectives, in Table 1, in the first line of the Concept paragraph, in the Discussion and in the Conclusion. Thank you. The meaning of "Long term care" Thank you for identifying this opportunity to improve the clarity of this concept. We have edited the fourth paragraph of the introduction to say that “this may include lifelong regular screening for early diagnosis of diabetes or cardiovascular disease, and ongoing support for maintenance of positive health behaviours”. We would hope that this gives clarity on the timeframe and the broad content of this care. Prevention programmes including DPP Thank you. We agree with your suggestion that such programmes are sufficiently important to necessitate their inclusion in this protocol, and have now done so in the introduction: "GPs can provide direct support and can connect women with parallel services, including Diabetes Prevention Programmes."1,2 However, a detailed discussion of diabetes prevention programmes is omitted in this general-practice focused review. The importance of preventing GDM recurrence Thank you for this comment. We agree that the protocol may benefit from emphasis on this important risk for these women. We have included a point on this within the introduction: "Data regarding the role for preconception care aimed at reducing the risk of GDM recurrence are also lacking.3,4,5. In spite of this, clinical practice guidelines frequently identify the importance of family planning and contraception for women with a history of GDM.6" Thank you. Grey Literature Thank you for raising this point. Grey literature may contain valuable sources, and, as you point out, may be particularly valuable for identifying educational interventions. However, the primary aim for this scoping review will be to synthesise empirical evidence from peer-reviewed publications. In the absence of an assessment of quality within a scoping review, this creates some standardisation of quality across the included studies. Furthermore, given the scope of the subject area, including grey literature would significantly expand the search and screening process, which may compromise the feasibility of this review. To improve the clarity of our protocol, we have stated our intention to omit grey literature more explicitly. Thank you. 10 year eligibility limit Thank you for this comment. Rationale clarified within the text: "To accommodate the rapidly evolving healthcare landscape, and to permit permeation of the practice-changing findings of the Hyperglycemia and Adverse Pregnancy Outcomes study 2008, the search years will be limited to the past 10 years (2014 or later)"7 Again, we are most grateful for your review, which identifies a number of opportunities to strengthen this protocol. Thank you. References: 1. Valabhji J, Barron E, Bradley D, Bakhai C, Fagg J, O’Neill S, et al. Early Outcomes From the English National Health Service Diabetes Prevention Programme. Diabetes Care. 2019 Dec 12;43(1):152–60. 2. Dennison RA, Ward RJ, Griffin SJ, Usher‐Smith JA. Women’s views on lifestyle changes to reduce the risk of developing Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for practice. Diabet Med. 2019 Jun;36(6):702–17. 3. Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, et al. Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of gestational diabetes mellitus. Am J Obstet Gynecol. 2023 Aug 1;229(2):158.e1-158.e14. 4. Quotah OF, Andreeva D, Nowak KG, Dalrymple KV, Almubarak A, Patel A, et al. Interventions in preconception and pregnant women at risk of gestational diabetes; a systematic review and meta-analysis of randomised controlled trials. Diabetol Metab Syndr. 2024 Jan 4;16:8. 5. Tieu J, Shepherd E, Middleton P, Crowther CA. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes - Tieu, J - 2017 | Cochrane Library. [cited 2025 Mar 20]; Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010211.pub3/full?cookiesEnabled 6. Ohene-Agyei P, Iqbal A, Harding JE, Crowther CA, Lin L. Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines. BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. 7. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8;358(19):1991–2002. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Flynn A. Peer Review Report For: The long-term general practice healthcare of women with a history of gestational diabetes: A Scoping Review Protocol [version 2; peer review: 2 approved] . HRB Open Res 2025, 8 :31 ( https://doi.org/10.21956/hrbopenres.15392.r45820) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-31/v1#referee-response-45820 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with HRB Open Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "The long-term general practice healthcare...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://hrbopenresearch.org/articles/8-31/v2" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://hrbopenresearch.org/articles/8-31/v2&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://hrbopenresearch.org/articles/8-31/v2" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('O'Flynn J et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://hrbopenresearch.org/articles/8-31/v2/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://hrbopenresearch.org/articles/8-31", templates : { twitter : "The long-term general practice healthcare of women with a history.... O'Flynn J et al., published by " + "@HRBOpenRes" + ", https://hrbopenresearch.org/articles/8-31/v2" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/14022/15532") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "15532"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "45824": 0, "45825": 0, "46020": 0, "46021": 0, "46022": 0, "46023": 18, "46024": 0, "46025": 0, "46026": 0, "46027": 0, "46028": 0, "46732": 0, "46029": 0, "46733": 7, "45816": 0, "45817": 0, "45818": 0, "45819": 0, "45820": 21, "45821": 0, "45822": 0, "45823": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "faea9250-0c2e-4c75-a8a6-a271f6bdc995"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); Are you a HRB-funded researcher? Submission to HRB Open Research is open to all HRB grantholders or people working on a HRB-funded/co-funded grant on or since 1 January 2017. Sign up for information about developments, publishing and publications from HRB Open Research. First Name * You must provide your first name Last Name * You must provide your last name Email * You must provide a valid email address Institution You must provide an institution. Submit Thank you! We'll keep you updated on any major new updates to HRB Open Research HRB Open Research Browse How to Publish About Contact RSS Cookie Notice Privacy Notice Legal Submit Your Research © F1000 Research Limited and its licensors ISSN 2515-4826 | Legal background var F1000platform = new F1000.Platform({ name: "hrb", displayName: "HRB Open Research", hostName: "hrbopenresearch.org", id: "5", editorialEmail: "[email protected]", infoEmail: "[email protected]" }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); }); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a020500499691640',t:'MTc3OTgzNTU1MQ=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();