##common.pageHeaderLogo.altText##

Original article

Vol. 155 No. 11 (2025)

Adherence to postpartum screening in women diagnosed with gestational diabetes: a retrospective single-centre experience in Switzerland

Cite this as:
Swiss Med Wkly. 2025;155:3610
Published
06.11.2025

Summary

STUDY AIMS: A history of gestational diabetes mellitus is a known risk factor for developing type 2 diabetes in the future. Therefore, screening for persistent dysglycaemia in the postpartum period is of utmost importance. However, follow-up rates tend to be low. The aim of this study was to investigate postpartum screening adherence at a tertiary care centre and to identify factors contributing to persistent dysglycaemia.

METHODS: A cohort of women with gestational diabetes mellitus diagnosed between 2015 and 2018 at the department of Obstetrics and Gynaecology, University Hospital Bern, Switzerland, was retrospectively studied. Ethnicity, parity, pre-pregnancy BMI, family history of diabetes mellitus, first trimester glycosylated haemoglobin (HbA1c), 75 g oral glucose tolerance test during pregnancy and in the postpartum period were analysed. Postpartum dysglycaemia was defined as overt diabetes (fasting plasma glucose ≥7.0 mmol/l and/or 2 hours plasma glucose ≥11.1 mmol/l for the 75 g oral glucose tolerance test), impaired glucose tolerance (2 hours plasma glucose 7.8–11.0 mmol/l) or impaired fasting glucose (plasma glucose 5.6–6.9 mmol/l). Parametric and non-parametric tests as well as multivariate regression were used. ROC analyses were performed to assess the prognostic accuracy of HbA1c and oral glucose tolerance test results at predicting postpartum dysglycaemia.

RESULTS: We included 489 women with gestational diabetes mellitus in our study. Of these, 217 (44.4%) returned for postpartum testing and 59/217 (27.2%) had an abnormal oral glucose tolerance test. Ethnicity was found to be a factor in adherence to follow-up. Specifically, women of African origin showed a significantly higher compliance than Asian or Caucasian women (61.8% vs 47.8% vs 34.5%, respectively; p = 0.04). The multivariate analysis revealed that obesity (OR: 3.64, 95% CI: 1.41–9.37) and first trimester HbA1c >5.7% (OR: 3.67, 95% CI: 1.28–10.52) are significantly associated with an increased risk of postpartum dysglycaemia.

CONCLUSION: Our study indicates that adherence to postpartum screening after gestational diabetes mellitus is low but in line with the existing experience. This is of particular concern as 1 of 4 women undergoing postpartum screening show some sort of disturbed glucose metabolism. In particular, women with higher first trimester HbA1c and/or obesity may warrant closer observation and motivation for testing as the risk for persistent metabolic disorders is increased.

References

  1. 1. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al.; on behalf of the American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023 [Erratum in: Diabetes Care. 2023 Feb 01; Erratum in: Diabetes]. Diabetes Care. 2023 Jan;46 Suppl 1:S19–40. 10.2337/dc23-S002
  2. 2. Coutinho T, Lamai O, Nerenberg K. Hypertensive Disorders of Pregnancy and Cardiovascular Diseases: Current Knowledge and Future Directions. Curr Treat Options Cardiovasc Med. 2018 Jun;20(7):56. 10.1007/s11936-018-0653-8
  3. 3. Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ. 2020 May;369:m1361. 10.1136/bmj.m1361
  4. 4. Boutari C, Mantzoros CS. A 2022 update on the epidemiology of obesity and a call to action: as its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on. Metabolism. 2022 Aug;133:155217. 10.1016/j.metabol.2022.155217
  5. 5. Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ. 2017 Feb;356:j1. 10.1136/bmj.j1
  6. 6. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al.; International Society for the Study of Hypertension in Pregnancy (ISSHP). Hypertensive Disorders of Pregnancy: ISSHP Classification, Diagnosis, and Management Recommendations for International Practice. Hypertension. 2018 Jul;72(1):24–43. 10.1161/HYPERTENSIONAHA.117.10803
  7. 7. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al.; International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar;33(3):676–82. doi: https://doi.org/10.2337/dc09-1848
  8. 8. Boulvain M, Brändle M, Drack G, Hoesli I, Honegger C, Lehmann R, et al. Screening des Gestationsdiabetes. SGGG [Internet] https://www.sggg.ch. Expertenbrief 37:2011. German available from: https://www.sggg.ch/fileadmin/user_upload/Dokumente/3_Fachinformationen/1_Expertenbriefe/De/37_Screening_des_Gestationsdiabetes_2011.pdf
  9. 9. Linnenkamp U, Greiner GG, Haastert B, Adamczewski H, Kaltheuner M, Weber D, et al. Postpartum screening of women with GDM in specialised practices: data from 12,991 women in the GestDiab register. Diabet Med. 2022 Jul;39(7):e14861. 10.1111/dme.14861
  10. 10. de Gennaro G, Bianchi C, Aragona M, Battini L, Baronti W, Brocchi A, et al. Postpartum screening for type 2 diabetes mellitus in women with gestational diabetes: is it really performed? Diabetes Res Clin Pract. 2020 Aug;166:108309. doi: https://doi.org/10.1016/j.diabres.2020.108309
  11. 11. Liu ZY, Zhao JJ, Gao LL, Wang AY. Glucose screening within six months postpartum among Chinese mothers with a history of gestational diabetes mellitus: a prospective cohort study. BMC Pregnancy Childbirth. 2019 Apr;19(1):134. doi: https://doi.org/10.1186/s12884-019-2276-9
  12. 12. Amylidi-Mohr S, Lang C, Mosimann B, Fiedler GM, Stettler C, Surbek D, et al. First-trimester glycosylated hemoglobin (HbA1c) and maternal characteristics in the prediction of gestational diabetes: an observational cohort study. Acta Obstet Gynecol Scand. 2023 Mar;102(3):294–300. 10.1111/aogs.14495
  13. 13. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al.; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May;358(19):1991–2002. 10.1056/NEJMoa0707943
  14. 14. Aubry EM, Raio L, Oelhafen S. Effect of the IADPSG screening strategy for gestational diabetes on perinatal outcomes in Switzerland. Diabetes Res Clin Pract. 2021 May;175:108830. doi: https://doi.org/10.1016/j.diabres.2021.108830
  15. 15. Assaf-Balut C, Bordiú E, Del Valle L, Lara M, Duran A, Rubio MA, et al. The impact of switching to the one-step method for GDM diagnosis on the rates of postpartum screening attendance and glucose disorder in women with prior GDM. The San Carlos Gestational Study. J Diabetes Complications. 2016;30(7):1360–4. doi: https://doi.org/10.1016/j.jdiacomp.2016.04.026
  16. 16. Bhavadharini B, Anjana RM, Mahalakshmi MM, Maheswari K, Kayal A, Unnikrishnan R, et al. Glucose tolerance status of Asian Indian women with gestational diabetes at 6weeks to 1year postpartum (WINGS-7). Diabetes Res Clin Pract. 2016 Jul;117:22–7. doi: https://doi.org/10.1016/j.diabres.2016.04.050
  17. 16. Cabizuca CA, Rocha PS, Marques JV, Costa TF, Santos AS, Schröder AL, et al. Postpartum follow up of gestational diabetes in a Tertiary Care Center. Diabetol Metab Syndr. 2018 Jan;10(1):2. doi: https://doi.org/10.1186/s13098-017-0303-4
  18. 18. Dalfrà MG, Burlina S, Del Vescovo GG, Anti F, Lapolla A. Adherence to a follow-up program after gestational diabetes. Acta Diabetol. 2020 Dec;57(12):1473–80. doi: https://doi.org/10.1007/s00592-020-01564-y
  19. 19. Jindal R, Siddiqui MA, Gupta N, Wangnoo SK. Prevalence of glucose intolerance at 6 weeks postpartum in Indian women with gestational diabetes mellitus. Diabetes Metab Syndr. 2015;9(3):143–6. doi: https://doi.org/10.1016/j.dsx.2015.04.016
  20. 20. Hung TH, Chuang YC, Chu FC, Huang L, Shaw SW, Hsieh TT, et al. Risk factors for abnormal postpartum glycemic states in women diagnosed with gestational diabetes by the International Association of Diabetes and Pregnancy Study Groups criteria. J Diabetes Investig. 2021 May;12(5):859–68. 10.1111/jdi.13400
  21. 21. Muche AA, Olayemi OO, Gete YK. Predictors of postpartum glucose intolerance in women with gestational diabetes mellitus: a prospective cohort study in Ethiopia based on the updated diagnostic criteria. BMJ Open. 2020 Aug;10(8):e036882. 10.1136/bmjopen-2020-036882
  22. 22. O’Reilly MW, Avalos G, Dennedy MC, O’Sullivan EP, Dunne F. Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus. Eur J Endocrinol. 2011 Dec;165(6):953–9. doi: https://doi.org/10.1530/EJE-11-0663
  23. 23. Schaefer-Graf UM, Klavehn S, Hartmann R, Kleinwechter H, Demandt N, Sorger M, et al. How do we reduce the number of cases of missed postpartum diabetes in women with recent gestational diabetes mellitus? Diabetes Care. 2009 Nov;32(11):1960–4. doi: https://doi.org/10.2337/dc09-0627
  24. 24. Quaresima P, Visconti F, Chiefari E, Puccio L, Foti DP, Venturella R, et al. Barriers to Postpartum Glucose Intolerance Screening in an Italian Population. Int J Environ Res Public Health. 2018 Dec;15(12):2853. doi: https://doi.org/10.3390/ijerph15122853
  25. 25. Heatley E, Middleton P, Hague W, Crowther C. The DIAMIND study: postpartum SMS reminders to women who have had gestational diabetes mellitus to test for type 2 diabetes: a randomised controlled trial – study protocol. BMC Pregnancy and Childbirth 2013 Apr 9;13(1):92.
  26. 26. Sarmiento AJ, Bernardo DC, Isip-Tan IT. A Randomized Controlled Trial on the Effectiveness of Short Message Service (SMS) Reminders in Improving Postpartum Follow-up among Gestational Diabetes Mellitus Patients. J ASEAN Fed Endocr Soc. 2019;34(1):62–72. doi: https://doi.org/10.15605/jafes.034.01.10
  27. 27. Van Ryswyk EM, Middleton PF, Hague WM, Crowther CA. Women’s views on postpartum testing for type 2 diabetes after gestational diabetes: six month follow-up to the DIAMIND randomised controlled trial. Prim Care Diabetes. 2016 Apr;10(2):91–102. doi: https://doi.org/10.1016/j.pcd.2015.07.003
  28. 28. Ambühl D, Bächler A, Baumann T, Jenni O. Leuchter Ha-Vinh R, Lips U, et al. Checklisten für die Vorsorgeuntersuchungen nach den Empfehlungen der Schweizerischen Gesellschaft für Pädiatrie. 4th ed. German; 2011.