Gestational diabetes - Major problems with post-partum testing.

BACKGROUND: Post-partum follow up testing of women with gestational diabetes mellitus (GDM) is important. All women, and their family doctors, receive written reminders. There are no recent major Australian reviews of the efficacy and compliance with this advice conducted in an ethnically representative population and using the current diagnostic criteria. AIM: The aim was to examine a cohort of women with recently diagnosed GDM and a completed pregnancy to determine what proportion had been tested and what were the difficulties in having testing carried out. METHODS: Women who were diagnosed with gestational diabetes and attended the Diabetes Service in 2017 were followed up in 2019. Attempted contact was made using an unidentified land line, an identifiable mobile phone and a postal survey. Compliance with testing advice was the major parameter considered. RESULTS: There were 714 women with GDM, 75 were excluded: 64 after pass one and 11 after pass two. In total, only 339/639 (53.1%) could be contacted. Of these women, 334 agreed to be surveyed; 207 (62.0%) had a post-partum test. Of the 127 women who had not had a test, 113 agreed to have an HbA1c. Only 13/113 (11.5%) had this done within a month. CONCLUSION: Contacting women, even within a short time after the pregnancy, is difficult. The number of post-partum tests carried out is suboptimal. Written advice to all women and their doctors does not appear to be working. A review of the cost effectiveness of this approach and development of new methods may be worthwhile.

The prevalence of diabetes after gestational diabetes - An Australian perspective.

BACKGROUND: Women with gestational diabetes mellitus (GDM) are likely to develop diabetes in later life. International reports and reviews indicate a variable but generally high rate of conversion. However, data from international reports are difficult to apply to an Australian population. AIM: To investigate in Australia, in a representative population, the prevalence of diabetes developing in women who have been diagnosed with one criteria and who have had uniform standards of clinical care. MATERIAL AND METHODS: This study considered women referred with a diagnosis of GDM according to the Australasian Diabetes in Pregnancy Society criteria and seen by one practitioner over a 20 year period, from 1991 to 2010. The area of referral had an ethnic distribution similar to the overall Australian demography. RESULTS: Despite, in some cases, being more than 25 years since the pregnancy, more than half the women were contactable and the majority agreed to have their diabetes status declared or determined. The overall prevalence was 10.3%. The prevalence at each 10 year age increment was more than twice the figure reported from the AusDiab study. A higher maternal body mass index and a positive family history of diabetes were the strongest predictive factors. The prevalence of undiagnosed diabetes was 0.9%. CONCLUSION: In a representative population, after GDM, the prevalence of diabetes of 10.3% was far lower than that reported internationally but was still about twice the rate for the overall Australian population.