Primary care management post gestational diabetes in Australia

Abstract

BackgroundWomen with a history of gestational diabetes (GD) have a high risk of developing diabetes and subsequent cardiovascular disease (CVD).AimTo assess whether diabetes screening and CVD risk screening occurred in general practice (GP) among postpartum women with GD.MethodsThis is a retrospective study of clinical record data of women with GD, under active GP management, from the MedicineInsight programme, run by Australia's National Prescribing Service MedicineWise, with GP sites located in Australia from January 2015 to March 2021. Documentation of screening for diabetes, assessment of lipids and measurement of blood pressure (BP) was assessed using proportions and mixed‐effects logistic regression with a log follow‐up time offset.ResultsThere were 10 413 women, with a mean age of 37.9 years (standard deviation, 7.6), from 406 clinics with a mean follow‐up of 4.6 years (interquartile range, 1.8–6.2 years) A total of 29.41% (3062/10 413; 95% confidence interval [CI], 28.53–30.28) had not been assessed for diabetes, 37.40% (3894/10 413; 95% CI, 36.47–38.32) were not assessed for lipids and 2.19% (228/10 413; 95% CI, 1.91–2.47) had no BP documented. In total, 51.82% (5396/10 413; 95% CI, 50.86–52.78) were screened for all three (diabetes + lipids + BP) at least once. Obesity, comorbidities and dyslipidaemia were associated with increased likelihood of screening. New diabetes diagnosis was documented in 5.73% (597/10 413; 95% CI, 5.29–6.18) of the cohort.ConclusionScreening for diabetes and hyperlipidaemia was suboptimal in this high‐risk cohort of women with prior GD. Improved messaging that women with a GD diagnosis are at high cardiovascular risk may improve subsequent screening.

Strategies to improve postpartum engagement in healthcare after high-risk conditions diagnosed in pregnancy: a narrative review

“…Health inequities in this study were identified beyond testing rates, with Indigenous people experiencing significantly longer times to any postpartum glucose test [ 43 ]. A large retrospective study reviewed the follow up of over 10,000 women with GDM from an estimated 12 weeks’ postpartum, until over 4 years postpartum, and found that 29% had not been assessed for diabetes [ 44 ]. This study excluded the postpartum period in order to highlight practices of long-term screening, finding that longer term follow-up also remains suboptimal [ 44 ].…”

“…A large retrospective study reviewed the follow up of over 10,000 women with GDM from an estimated 12 weeks’ postpartum, until over 4 years postpartum, and found that 29% had not been assessed for diabetes [ 44 ]. This study excluded the postpartum period in order to highlight practices of long-term screening, finding that longer term follow-up also remains suboptimal [ 44 ]. The authors also found that 6% of the whole cohort received a new diagnosis of diabetes within this timeframe, highlighting the importance of testing in the postpartum period and beyond [ 44 ].…”

“…This study excluded the postpartum period in order to highlight practices of long-term screening, finding that longer term follow-up also remains suboptimal [ 44 ]. The authors also found that 6% of the whole cohort received a new diagnosis of diabetes within this timeframe, highlighting the importance of testing in the postpartum period and beyond [ 44 ]. In terms of follow up of HDP in the postpartum period, 94.5% of a group of women with diagnosis of pre-eclampsia in the previous 2 years reported blood pressure measurement since birth, but screening for metabolic abnormalities occurred in less than half [ 45 ].…”