Elpida Vounzoulaki, Kamlesh Khunti, Clare L. Gillies
Gestational diabetes is a relatively common pregnancy complication, defined as diabetes first diagnosed in pregnancy, that is clearly not either pre-existing type 1 or type 2 diabetes. [1] The prevalence of gestational diabetes has increased over the last few years, due to a rise in both the prevalence of obesity and the number of women giving birth at a more advanced age. Although gestational diabetes typically resolves following labour, a large proportion of women affected by the condition develop type 2 diabetes in later life.
In our recent systematic review and meta-analysis, published in The BMJ, we compared the risk of subsequent progression to type 2 diabetes between women diagnosed with gestational diabetes during pregnancy and those with a normoglycemic pregnancy. We found that women with a previous diagnosis of gestational diabetes have a nearly tenfold higher risk of developing type 2 diabetes compared to those with a normoglycemic pregnancy.
There is a growing body of evidence indicating that gestational diabetes and type 2 diabetes share common pathogenic mechanisms and risk factors, suggesting that gestational diabetes could serve as a natural way to identify individuals at high risk for future type 2 diabetes. [2] While the frequency of post-partum glucose screening varies based on guidelines and study population, it has been observed that, overall, only half of women diagnosed with gestational diabetes in pregnancy attend post-partum screening. [3] Both personal factors and factors associated with the healthcare system are known to influence screening attendance. Women with a history of gestational diabetes are often unaware of the magnitude of risk for future type 2 diabetes, a fact that highlights important gaps in patient education and poor communication between patients and clinicians. [4] Other than patients, clinicians are often unfamiliar with guidelines for post-partum screening and unsure of whether the responsibility of recommending screening lies within primary or secondary care. [5] Previous research has identified lack of public health commissioned services targeting women with previous gestational diabetes by focusing on their individual needs, which has an important impact on screening attendance. [6]
Our research highlights a persistent problem in clinical practice that requires addressing. The substantially higher risk of type 2 diabetes in women diagnosed with gestational diabetes identified in our systematic review is perhaps not surprising, considering both poor screening uptake and lack of structured post-partum preventative care. There is an urgent need to promote systematic post-partum screening of women with gestational diabetes and interventions to motivate women to adopt dietary and lifestyle changes to prevent the development of type 2 diabetes. As both the approach adopted by clinicians and the patient’s interaction with the healthcare system have a strong impact on screening attendance, there is an urgent need to adjust healthcare provision, focusing on patients’ individual needs. Education has the potential to increase the patient’s understanding of the subsequent risk of type 2 diabetes, reduce concerns associated with the possibility of a diagnosis, and promote the adoption of a healthy lifestyle to improve long-term health outcomes.
Future research could further investigate potential strategies to improve screening uptake among these women and evaluate the effectiveness and costs of interventions to prevent type 2 diabetes, across heterogenous populations and over long time periods.
Elpida Vounzoulaki, Doctoral Student in Diabetes Epidemiology, Diabetes Research Centre, Leicester General Hospital, University of Leicester. Twitter: @Elpida_Vnz
Kamlesh Khunti, Professor of Primary Care Diabetes and Vascular Medicine, Diabetes Research Centre, Leicester General Hospital, University of Leicester.
Clare L. Gillies, Lecturer in Medical Statistics, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
Competing interests: See declaration on research paper
References:
1. American Diabetes Association (ADA). Classification and diagnosis of diabetes: Standards of medical care in diabetes 2019. Diabetes Care. 2019;42(January):S13–28.
2. Buchanan TA, Xiang A, Kjos SL, Watanabe R. What is gestational diabetes? Diabetes Care. 2007;30(SUPPL. 2).
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5. Bernstein JA, McCloskey L, Gebel CM, Iverson RE, Lee-Parritz A. Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes. BMJ Open Diabetes Res Care. 2016;4(1):1–7.
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