Abstract
BackgroundIncidence of type 2 diabetes is high after gestational diabetes mellitus (GDM). We aimed to evaluate the adherence to follow-up six-weeks postpartum visits in secondary care after GDM and glucose monitoring in primary care longer than 12–14 months after delivery and the years thereafter. In addition, we examined the women’s lifestyle after delivery.MethodsA cross-sectional follow-up survey among women with a history of GDM and their general practitioners (GP). Rates of attendance at the six-weeks postpartum visit and glucose testing were obtained from hospital records, over the period 2011–2012. Rates of annual follow-up postpartum glucose testing were assessed by a survey among their GP’s. Lifestyle of the women on diet and exercise was assessed by questionnaire in 2015.ResultsIn total 197 women were eligible for the study. Of these, 156 (79%) attended the six-weeks postpartum visit at the diabetes outpatient clinic and in 145 (93%) of these women glucose testing was performed. In total 77 (39%) women responded to the invitation to participate in this study and filled in the lifestyle questionnaire. About one third of the women met the recommendations for sufficient physical activity. A majority of them did not fulfil the Dutch guidelines on healthy diet – fruit intake 35.1%, vegetables intake 7.8%. Of the 74 invited GP’s, 61 responded (82%), only 12 (20%) reported that they had performed a follow-up glucose testing within >12–14 months postpartum. Of these women, five were tested only in the first year of follow-up, five also in the second year, and two were tested for three consecutive years.ConclusionsDespite the high attendance rate of six-weeks postpartum visit and glucose testing, we observed low rates of longer-term follow-up regarding postpartum glucose testing. Moreover, we found a suboptimal adherence to healthy lifestyle for women with a history of GDM.
Highlights
Incidence of type 2 diabetes is high after gestational diabetes mellitus (GDM)
There were no differences in maternal age, family history of GDM, previous GDM, insulin requirements, large for gestational age (LGA) infant at delivery, and gestational age at delivery
Of the 197 eligible women, 156 (79%) attended the sixweeks postpartum office visit at the diabetes outpatient clinic in secondary care
Summary
We aimed to evaluate the adherence to follow-up six-weeks postpartum visits in secondary care after GDM and glucose monitoring in primary care longer than 12–14 months after delivery and the years thereafter. In most women with GDM glucose intolerance resolves after delivery, women with a history of GDM are at increased risk of developing impaired glucose tolerance and type 2 diabetes mellitus (DM). National and international guidelines recommend follow-up glucose testing in women with a history of GDM [5, 6]. Patients are referred back to their general practitioner (GP), who has a central role in our health-care system and is the most obvious caregiver to perform annual follow-up glucose testing and simultaneously to motivate women to adopt and maintain a healthy lifestyle to prevent type 2 DM
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