Window of Opportunity: Postpartum Screening of Women with Gestational Diabetes for Early Detection of Prediabetes and Type 2 Diabetes

Abstract

Gestational diabetes is a condition characterized by glucose intolerance during pregnancy, with defined approaches for screening, treatment, and follow-up. It is associated with a variety of adverse birth outcomes, including excessive fetal weight gain and related increases in the rate of cesarean delivery and perinatal injury as well as increased risk for developing type 2 diabetes for women who have had gestational diabetes. A diagnosis of gestational diabetes may also be a manifestation of pre-existing type 2 diabetes. Nonetheless, a substantial proportion of women with a history of gestational diabetes fail to receive the recommended postpartum glucose screening. This failure to conduct follow-up screening of women with gestational diabetes after delivery represents a missed opportunity for earlier diagnosis of diabetes, and chance to increase the awareness of women of their future risk for developing diabetes. This paper explores the barriers contributing to the lack in follow-up screening and makes recommendations about addressing these problems.

Barriers to postpartum follow-up of mothers with gestational diabetes mellitus and its implications: a mixed method study

“…In low-and middle-income countries (LMIC), the barriers include lack of trained healthcare providers, high staff turnover, lack of standard protocols, lack of consumables and equipment, financing of health services and treatment, lack of or poor referral systems, feedback mechanisms and follow-up systems, distance to health facility [13], inadequate supply of glucose [14] and lack of nearby health facility in the locality [15]. Barriers in healthcare in high-income countries included perception of doctors about the timing of screening in postpartum, not giving priority to postpartum screening, lack of awareness and adherence to postpartum screening guidelines [16][17][18] and lack of consensus about the type of screening test [19]. Clinicians' perception that "screening guidelines are inconsistent" was also identified as a barrier from the clinicians' side [10].…”

Recall for postpartum follow-up of women with gestational diabetes mellitus: Climbing a mountain

“…Early postpartum follow-up of women with a history of gestational diabetes mellitus (GDM) provides an opportunity to assess health condition of mothers as well as their offspring health [ 1 ]. GDM is considered as the strongest predictor of type 2 diabetes, thus follow-up of women with recent GDM can lead to early diagnosis and management of diabetes and other metabolic disorders outcomes [ 2 ].…”

Opportunities and Strategies for Meaningful Engagement with Women with Gestational Diabetes Mellitus

“…5 This could be due to barriers such as the patient’s lack of awareness regarding their risk, the provider’s confusion regarding the recommendations for screening, or systemic barriers such as limited access to the health care system. 6…”