Gestational Diabetes and the Postpartum Gap: A Narrative Review of Why Follow-Up Screening Fails and What Recovers It
DOI:
https://doi.org/10.5281/zenodo.22258276Keywords:
Gestational diabetes, Postpartum screening, Glucose tolerance test, Non-attendance, Care transitionAbstract
Women who have had gestational diabetes carry a lifetime risk of type 2 diabetes of roughly 40 to 70 per cent, and guidance
recommends a glucose tolerance test four to twelve weeks after delivery. Fewer than half receive it. In a UK cohort of 607 women,
65 per cent attended, and among those tested 21.6 per cent had persistent dysglycaemia and 2.8 per cent had type 2 diabetes. The
finding that should reshape how the problem is understood is what happened to the others: women who did not attend converted to
type 2 diabetes by two years at 11.4 per cent against 2.5 per cent among those who did, so non-attendance selects the higher-risk
group rather than the lower. Attending a postpartum appointment does not solve it either, since in one series 83 per cent attended
a visit and about a third of those were tested. Reminders raise completion substantially, from 14.3 per cent without them to as
much as 45.9 per cent, and a dedicated coordinator sustained 75.6 per cent over five years. This review sets out where the
pathway loses people and what has been shown to recover them.
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