Gestational diabetes mellitus: a call for systematic tracing

Area of Science:

• Endocrinology
• Obstetrics
• Public Health

Background:

• Gestational diabetes mellitus (GDM) increases the lifetime risk of developing diabetes mellitus (DM) by up to 50% in women.
• Postpartum follow-up is crucial for early intervention programs aimed at preventing diabetes progression in women with a history of GDM.
• A significant proportion of women with GDM do not attend recommended postpartum screening tests.

Purpose of the Study:

• To determine the response rate to postpartum oral glucose tolerance testing (OGTT) among women with a history of GDM.
• To identify clinical characteristics of women who do not attend postpartum diabetes screening.

Main Methods:

• A cohort of 105 women who attended a Gestational Diabetes Joint Clinic (GDJC) were divided into three groups based on postpartum OGTT response.
• Group A: Non-responders (did not attend OGTT). Group B: Responders with normal OGTT. Group C: Responders with abnormal OGTT (2-hour plasma glucose ≥ 7.8 mmol/L).
• Comparison of weight, glycaemic parameters, and clinical characteristics during gestation between the groups.

Main Results:

• The non-response rate to postpartum diabetes screening was 37.1%.
• Non-responders were significantly heavier, had higher glycosylated hemoglobin and antepartum OGTT values, and delivered larger babies compared to responders with normal postpartum OGTT.
• Characteristics of non-responders resembled those of women with abnormal postpartum OGTT results.

Conclusions:

• Women who do not attend postpartum screening for GDM may be at similar risk for glucose intolerance as those with abnormal test results.
• Enhanced call/recall systems and patient education are necessary to improve postpartum attendance for diabetes screening in women with GDM history.
• Targeted interventions for non-responders could help prevent the progression to type 2 diabetes.