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Women with gestational diabetes missing out on postnatal care

Just 13 per cent of women who have had gestational diabetes receive the right care after giving birth, leaving them at increased risk of developing Type 2 diabetes, research reveals today.

The study by researchers from the University of Surrey, presented today at the Diabetes UK Professional Conference 2013, used data on nearly 800 women with gestational diabetes from GP practices across England. It found that only 102 (13 per cent) of these women were recorded as having received one or more blood glucose tests following the delivery, as recommended by national guidelines.

NICE recommendations

The National Institute for Health and Clinical Excellence (NICE) recommends that women who have had gestational diabetes are monitored post-birth, receiving blood glucose tests six weeks after delivery and then annually. 

Gestational diabetes affects around 3.5 per cent of pregnancies in England and Wales. It usually occurs in the second trimester of pregnancy and in most cases can be controlled through diet. Following delivery, women with gestational diabetes are at increased risk of developing Type 2 diabetes, most commonly in the first five years after the birth.

Results showed that for those women whose blood glucose levels were tested, eight per cent were outside of normal levels, two per cent of women had developed Type 2 diabetes, and six per cent showed signs of prediabetes.

Monitoring of mothers' health "crucial"

Simon O’Neill, Director of Health Intelligence and Professional Liaison at Diabetes UK, said, "With gestational diabetes, it is crucial for healthcare professionals to monitor the mother’s health closely following the birth of her child. This means those women who are found to be at increased risk of Type 2 diabetes can get the support they need to reduce this risk and ultimately help to prevent the onset of a lifelong condition. For those who do develop Type 2 diabetes, they could get the advice and treatment they need as soon as possible to prevent the complications associated with the condition.

Curbing the rise in cases

"We are already seeing a phenomenal rise in the cases of Type 2 diabetes in this country. Mothers who have had gestational diabetes are at increased risk, so supporting and monitoring them should be playing a role in curbing the rise in the number of people with the condition.

"Tests should be offered as a matter of course, and new mothers with gestational diabetes should feel comfortable asking their doctor for follow-up checks. It is only by doing this that we can give mothers who have had gestational diabetes the best possible chance of not going on to develop Type 2 diabetes."

"Haphazard" follow-up

Lead researcher Dr Andrew McGovern said, "The short-term follow-up of women with gestational diabetes appears to be haphazard with no set date of recall, which goes against national guidance. There are a number of strategies which could be implemented in primary care to ensure that women are not left at unnecessary risk of developing Type 2 diabetes.

Recalls and reminders

"This study shows the power of using electronic records to identify gaps in quality, especially in primary care. These same records could be used to create recalls and reminders to close this quality gap and make sure that women receive the care they need."

Conclusions of the study include recommendations on compiling a gestational diabetes recall register, setting up computer alerts to facilitate annual recall and the inclusion of screening in pay-for-performance program targets, such as the Quality and Outcomes Framework.

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