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A service improvement project to improve follow up screening rates of women with gestational diabetes

02 March 2024
Volume 35 · Issue 3


Diabetes in pregnant women presents significant implications for long-term health. The best way to manage them in practice is outlined here by Joanna Stace

A history of Gestational Diabetes Mellitus (GDM) can have significant implications for women's long-term health. Despite these risks, primary care rates for post-natal screening are low.

A Service Improvement Project (SIP) was implemented as part of an MSc in Advanced Diabetes Care undertaken at Birmingham City University. Its aims were to improve post-natal follow-up care for women with GDM, reduce the risk of developing T2DM enhancing their long-term health.

A key success of the SIP is the improved knowledge of the importance of post-natal screening amongst staff and women. Increased numbers of women being correctly coded and offered post-natal screening highlighting the importance of healthcare integration for better patient outcomes. Work continues to improve referral rates and attendance of the National Diabetes Prevention Programme with the roll out of an Electronic Care Pathway.

Gestational diabetes mellitus (GDM) is defined as hyperglycemia first recognised during pregnancy (World Health Organisation [WHO], 2013). In 2017, it was approximated that 21.3million live births were impacted by various forms of hyperglycaemia. Of these, roughly 18.4 million were attributed to GDM, constituting 86.4% of all instances of hyperglycemia in pregnancy (Cho et al, 2018).

A history of GDM is shown to have significant implications for long term health, those affected face an 8–10 times greater risk of developing T2DM (Adam, 2023) and a two-fold higher risk of future cardiovascular events (Kramer et al, 2019). Incidences of GDM and T2DM are increasing worldwide, resulting in huge healthcare and economic costs (Bellamy et al, 2009).

Due to these associated risks it is advisable to conduct follow-up screening after a pregnancy complicated by GDM. In the United Kingdom, National Institute of Clinical Excellence guidelines (NG3) (2020) recommended that women with GDM should have post-natal screening for T2DM. These guidelines stipulate women should have a Fasting Blood Glucose (FBG) test at 6-13 weeks post-natal, or an HbA1c or FBG test done after 13 weeks post-natal, repeated annually for life. It also provides recommendations for appropriate referrals to the National Diabetes Prevention Programme (NDPP) depending on results.

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