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REVIEW article

Front. Glob. Womens Health
Sec. Maternal Health
Volume 5 - 2024 | doi: 10.3389/fgwh.2024.1391213
This article is part of the Research Topic Pregnancy Complications Forecast Women’s Future Health View all 4 articles

Implementing care for women with gestational diabetes after delivery -the challenges ahead

Provisionally accepted
Pei Chia Eng Pei Chia Eng 1,2,3*Ada Teo Ada Teo 4Tong Wei Yew Tong Wei Yew 2,4Chin Meng Khoo Chin Meng Khoo 2,4
  • 1 Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
  • 2 National University of Singapore, Singapore, Singapore
  • 3 Imperial College London, London, England, United Kingdom
  • 4 National University Hospital, Singapore, Singapore

The final, formatted version of the article will be published soon.

    Gestational diabetes (GDM), defined as glucose intolerance during pregnancy, affects one in six pregnancies globally and significantly increases a woman’s lifetime risk of type 2 diabetes mellitus (T2DM). Being a relatively young group, women with GDM are also at higher risk of developing diabetes related complications (e.g cardiovascular disease, non-alcoholic fatty liver disease) later in life. Children of women with GDM are also likely to develop GDM and this perpetuates a cycle of diabetes, escalating our current pandemic of metabolic disease. The global prevalence of GDM has now risen by more than 30% over the last two decades, making it an emerging public health concern. Antepartum management of maternal glucose is unable to fully mitigate the associated lifetime cardiometabolic risk. Thus, efforts may need to focus on improving care for women with GDM during the postpartum period where prevention or therapeutic strategies could be implemented to attenuate progression of GDM to DM and its associated vascular complications. However, strategies to provide care for women in the postpartum period often showed disappointing results. This has led to a missed opportunity to halt the progression of impaired glucose tolerance/impaired fasting glucose to DM in women with GDM. In this review, we examined the challenges in the management of women with GDM after delivery and considered how each of these challenges are defined and could present as a gap in translating evidence to clinical care. We highlighted challenges related to postpartum surveillance, postpartum glucose testing strategies, postpartum risk factor modification, and problems encountered in engagement of patients/providers to implement interventions strategies in women with GDM after delivery. We reasoned that a multisystem approach is needed to address these challenges and to retard progression to DM and cardiovascular disease (CVD) in women with GDM pregnancies. This is very much needed to pave way for an improved, precise, culturally sensitive and wholistic care for women with GDM.

    Keywords: gestational diabetes, Postpartum, cardiovascular disease, Impaired glucose tolerance, Oral glucose tolerance test (OGTT)

    Received: 25 Feb 2024; Accepted: 31 Jul 2024.

    Copyright: © 2024 Eng, Teo, Yew and Khoo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Pei Chia Eng, Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.