Reducing risk of subsequent type 2 diabetes following gestational diabetes in pregnancy

We have included an ethnically and socially diverse range of women in our study, including 66% from minority ethnicities. There were four key themes we found in our discussions with women which limited engagement with type 2 diabetes prevention following a pregnancy with GDM:

• Left at Sea
• Building a concrete picture
• Life gets in the way
• I need the GP in my corner

Left at sea

Women felt left at sea postpartum, in dramatic contrast to the close management of GDM during their pregnancy. Whilst they knew about increased future risk of type 2 diabetes following a pregnancy with GDM women were unsure about whether this related to them and what they should be doing, if anything, to mitigate their future risk. This was exacerbated by having received mixed messages from healthcare teams – with diabetes care teams highlighting future risks but the messages from delivery midwifery teams suggesting everything was back to normal following the birth. Women felt very much alone, unsure and unsupported with regards to future type 2 diabetes prevention.

Building a concrete picture

Women who were aware of potential risks and who were motivated to act still struggled to build a concrete picture of what they personally needed to do. They struggled to understand their personal risk, especially if they did not consider themselves overweight.  It was difficult to make sense of fragmented information sources, some were not clear about how the physiology differed between GDM and type 2 diabetes and what that meant for lifestyle changes. Any guidance they were given tended to be quite vague. Most women would consider annual HbA1C screening but 46% were not aware of it. Even if they were there was a lack of clarity amongst women about what it was measuring and what the reference ranges meant.

Life gets in the way

Postpartum women prioritised the needs of their baby and family over their own health, which made any immediate consideration about maintaining habits developed during pregnancy. Some women tried, but motivation dwindled and it was hard particularly with breastfeeding. Most women felt that 6-12 months would be an appropriate window to be reminded about what they could do in the future to reduce their type 2 diabetes risk. For those facing social challenges and complications following pregnancy, the latter experienced especially by women of minority ethnicities, consideration of future type 2 diabetes risk was simply not a priority with other more pressing considerations.

I need my GP in my corner

Women perceived that their GP was an important ally and partner in the prevention of future type 2 diabetes, although they reported falling through the cracks between primary and secondary care, with some GPs seemingly unaware they had had GDM. Women would like a flag on the system that they have had GDM and suggest they would like GPs to consider their type 2 diabetes risk alongside their general care. They felt it crucial that they were reminded when their HbA1C annual screen was due and welcomed anything that streamlined the making of the appointment, stressing the continuing challenge of accessing primary care for non-urgent appointments.

You can download the full presentation presented at the Society for Academic Primary Care conference 2023 here: postpartum factors