Discovering and Preventing Type 2 Diabetes in New Mothers

Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus

Original source: Nature Clinical Practice Endocrinology & Metabolism (2008) 4, 552-558
Authors: Rhonda Bentley-Lewis (corresponding author), Sue Levkoff, Alison Stuebe and Ellen W Seely
Publication date: 9 September 2008
DOI (digital document ID): 10.1038/ncpendmet0965
Requires subscription? No
Publicly-available abstract: Yes

Synopsis:
This Continuing Medical Education (CME) course is aimed at obstetrician/gynecologists and primary care physicians, who take care of women before, during, and after childbirth. A woman who has had gestational (pregnancy) diabetes is at increased risk of developing Type 2 diabetes. The aim of this course is to look at the need to monitor these women in order to prevent, or to quickly diagnose, Type 2 diabetes following childbirth. This requires screening for diabetes at one or more points after delivery.

In current medical practice, there are a number of conflicting guidelines for diabetes screening after delivery: while the American Diabetes Association (ADA) suggests either fasting blood glucose measurement or an Oral Glucose Tolerance Test at 6-12 weeks after delivery, with follow-ups every three years if the tests are normal, or every year if the test indicates impaired glucose tolerance. The World Health Organization (WHO) suggests a single follow-up six weeks or longer after delivery. The American College of Obstetricians and Gynecologists has no specific recommendation for diabetes screening after delivery. As a result, many women who have had gestational diabetes do not get follow-up screening.

Beyond the differing guidelines, the authors suggest several reasons that women may not be receiving appropriate postpartum diabetes screening. These include confusion as to whether this should be done by the obstetrician or the woman's primary care physician, whether or not she had a postpartum visit with the obstetrician, and whether or not she was instructed to get this screening.

The authors suggest several known methods for minimizing the risk of developing Type 2 diabetes after childbirth, including diet and exercise, weight loss, breastfeeding, and the preventative use of oral antidiabetes medications.

The authors suggest both monitoring new mothers who have had GDM 6-12 weeks after birth, and continuing to monitor them regularly thereafter.

Reliability: The authors are medical doctors with additional qualifications in public health, women's health, and psychiatry, and are associated with top-name institutions. The course is presented in conjunction with a peer-reviewed publication; the information is well-documented and the source publications are also peer-reviewed.

Practical Applications: The goal of CME courses is for doctors to keep up with current research and medical practice, with the end result of improving their ability to keep their patients healthy. Vigilant screening and attention to other diabetes risk factors will keep these mothers healthier for longer periods of time, lessen their risk of complications of diabetes, and potentially provide healthier role models for their children.

For further reading: The article's bibliography section has a number of online sources for follow-on reading.

This synopsis was based on the CME version of the complete article.