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. 2011 Oct;61(591):e611-9.
doi: 10.3399/bjgp11X601316.

Missed opportunities for diabetes prevention: post-pregnancy follow-up of women with gestational diabetes mellitus in England

Mary Pierce  1 , Jo Modder, Iman Mortagy, Anna Springett, Heather Hughes, Stephanie Baldeweg
Affiliations

Missed opportunities for diabetes prevention: post-pregnancy follow-up of women with gestational diabetes mellitus in England

Mary Pierce et al. Br J Gen Pract. 2011 Oct.

Abstract

Background: Women with gestational diabetes mellitus (GDM) should be followed-up to exclude ongoing diabetes and for prevention of type 2 diabetes. The National Institute for Health and Clinical Excellence (NICE) diabetes in pregnancy guideline recommends checking fasting plasma glucose (FPG) at 6 weeks postpartum (short term), and annually thereafter (long term).

Aim: To examine the reported practice regarding GDM follow-up.

Design and setting: Nationwide postal survey in England 2008-2009.

Method: Questionnaires were distributed to a consultant diabetologist and obstetrician in all maternity units, and to a random sample of general practices (approximately 1 in 5).

Results: Response rates were: 60% (915/1532) GPs, 93% (342/368) specialists; 80% of GPs and 98% of specialists reported women with GDM had short-term follow-up. More GPs (55%) than specialists (13%) used a FPG test to exclude ongoing diabetes; 26% of GPs versus 89% of specialists thought the hospital was responsible for ordering the test. Twenty per cent of GPs had difficulty in discovering women had been diagnosed with GDM in secondary care. Seventy-three per cent of specialists recommended long-term follow-up; only 39% of GPs recalled women with GDM for this. A minority of GPs and specialists had joint follow-up protocols.

Conclusion: Follow-up of GDM in England diverged from national guidance. Despite consensus that short-term follow-up occurred, primary and secondary care doctors disagreed about the tests and responsibility for follow-up. There was lack of long-term follow-up. Agreement about the NICE guideline, its promotion and effective implementation by primary and secondary care, and the systematic recall of women with GDM for long-term follow-up is required.

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Figures

Figure 1
Figure 1
Protocols in primary and secondary care.
See this image and copyright information in PMC

Comment in

  • Alcohol and pregnancy.
    Jesuratnam G, Oakeshott P, Mukherjee R. Jesuratnam G, et al. Br J Gen Pract. 2011 Dec;61(593):719. doi: 10.3399/bjgp11X613025. Br J Gen Pract. 2011. PMID: 22137393 Free PMC article. No abstract available.
  • Commissioning maternity care: little room for manoeuvre?
    Jewell D. Jewell D. Br J Gen Pract. 2011 Oct;61(591):598-9. doi: 10.3399/bjgp11X601217. Br J Gen Pract. 2011. PMID: 22152824 Free PMC article. No abstract available.

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