Long-term effectiveness of a reminder system for postpartum glucose intolerance screening in gestational diabetes

Women with a history of gestational diabetes (GDM) have an increased risk of developing type 2 diabetes later in life. We evaluated the long-term feasibility and effectiveness of a regionally implemented GDM recall register to stimulate postpartum screening and assess (pre)diabetes prevalence up to 10 years postpartum.

We evaluated the "Sweet Pregnancy" GDM recall register, implemented in the northern part of Belgium, from 2009 to 2025. Women with a history of GDM received annual reminders for screening with a fasting plasma glucose in primary care. Response rates, self-reported screening uptake, and cumulative incidence of (pre)diabetes were analyzed.

27,173 women were registered with a mean follow-up of 4.4 years. The yearly response rates (among both responders and non-responders combined) varied from 48.4% (11,048) after the first year to 34.3% (4,116) after the fifth year, and 27.6% (1,190) after 10 years. Among responders, during the follow-up period of 3 and 5 years, 80.4% and 81.9% received at least one screening test, respectively. Non-responders were more often under 30 years of age (45.4% vs. 42.0%, p < 0.001) and obese (32.6% vs. 24.8%, p < 0.001) compared to responders. After 10 years, the cumulative incidence of diabetes was 11.0% and of impaired fasting glucose 34.7%.

This large-scale register implemented in normal routine, up to 10 years of follow-up, indicates a feasible and effective reminder system to stimulate postpartum diabetes screening in women with prior GDM. The high cumulative incidence of (pre)diabetes underscores the importance of long-term follow-up and targeted interventions to prevent progression to type 2 diabetes in this high-risk population.