Only half of these women are screened for diabetes, lipid levels and abnormal blood pressure, despite the higher risks.
Women with gestational diabetes are missing out on vital diabetes or cardiovascular disease screening, according to new Australian research.
Only half of these women were screened for diabetes, elevated lipids and abnormal blood pressure in the five years after their diagnosis, despite being at an elevated risk for both diabetes and cardiovascular disease, the study found.
Professor Helena Teede, epidemiologist and professor of Women’s Health at Monash University, blamed a lack of communication between those treating women in hospital and those responsible for follow-up care. “The barriers are around a lack of good transitioning of care from hospital-based or obstetric specialty-based care to primary care,” she said.
Researchers analysed health records from more than 10,000 Australian women with a recorded diagnosis of GDM and at least one GP visit between 2015 to 2021. All participants were under active care, having had at least three GP visits in the two years prior, and had received their diagnosis of GDM from their current GP.
They found that almost one in three women were not assessed for diabetes with either fasting glucose or HbA1c testing during the follow-up, which was an average of five years.
Similarly, almost 40% of these women were not assessed for elevated lipids during follow-up. The good news was that only 2% of participants appeared to miss out on blood pressure testing, which the authors attributed to the ease and accessibility of measurement.
In total, only 50% were tested for all three.
These participants were diagnosed with type 2 diabetes at a rate four times that of their peers, with 6% receiving a diagnosis in the follow-up.
While two in three of these women were screened in accordance with the RACGP recommendation of a test at least every three years, these guidelines are less strict than the NICE and Australasian Diabetes in Pregnancy Society recommendations which advocate for a test every one to two years.
Moreover, the researchers noted their figures may have overestimated the true figures as this study only captured actively managed patients.
“Our findings… indicate that despite guidelines and persistent public health efforts to highlight the need for diabetes testing and cardiovascular risk screening among people at risk, the rate of testing has further to improve in Australian primary care.”
Professor Teede told TMR Australia needed to move away from a “one-size-fits-all” approach to screening. Instead, it was time for evidence-based guidelines tailored to individual populations, that considered the prevalence as well as timing of conversion from GDM into type 2 diabetes to algorithmically calculate patients’ risk.
“Understanding of which populations convert [from GDM to type 2 diabetes], when and by what percentage is what we need to be able to inform nuancing of the guidelines,” she told TMR.
“At the moment in Australia, we are uniquely positioned because we have a diabetes registry. But unless women give consent, which they don’t currently ask for, then GPs aren’t notified by the registry [of a GDM diagnosis].”
“The current female population is at much higher risk than before: we have children older; we have children at a much higher weight. When you combine these two, plus being far less fit than perhaps we were in previous generations, pregnancy comes at a much higher risk than it used to,” Professor Teede said.
“Women are at a high risk of being unwell when pregnant.”
“Self-care is at the absolute bottom [on a mother’s list of priorities] and self-care prevention is even lower.”
The researchers found lower screening rates among Indigenous patients and those less educated, as well as smokers.
They did find that additional known risk factors for diabetes or cardiovascular disease increased the likelihood of screening, including obesity, dyslipidaemia and polycystic ovarian syndrome. The study did not include routine 6–12-week post-partum glucose tolerance testing, as this was considered part of GDM care. Screening was counted as testing from approximately 12 weeks post-delivery.
