What is the recommended follow-up for a patient diagnosed with gestational diabetes mellitus (GDM) nine weeks postpartum?

From the Guidelines

For a patient diagnosed with gestational diabetes who is now nine weeks postpartum, the recommended follow-up is a 75-gram oral glucose tolerance test (OGTT) to be performed between 4-12 weeks after delivery, as stated in the 2022 standards of medical care in diabetes 1. Since this patient is already at nine weeks postpartum, this test should be scheduled immediately if not already completed. The OGTT involves measuring fasting blood glucose, followed by administration of a 75-gram glucose solution and subsequent measurements at 1 and 2 hours. This test is crucial because approximately 5-10% of women with gestational diabetes will have persistent diabetes postpartum, and many others may have prediabetes. Some key points to consider in the follow-up of these patients include:

• Lifelong screening for diabetes at least every 3 years, as these women have a significantly increased risk of developing type 2 diabetes later in life 1
• Lifestyle modifications including:
  • Maintaining a healthy weight
  • Regular physical activity (at least 150 minutes per week)
  • A balanced diet to reduce the risk of future diabetes
• Breastfeeding should also be encouraged as it may provide additional metabolic benefits and reduce the risk of developing diabetes. If the OGTT results are normal, the patient should still be advised on the importance of lifestyle modifications and regular screening for diabetes. Additionally, if the patient is found to have prediabetes, intensive lifestyle interventions and/or metformin should be considered to prevent diabetes, as recommended by the 2022 standards of medical care in diabetes 1.

From the Research

Follow-up for Gestational Diabetes

• The recommended follow-up for a patient who was diagnosed with gestational diabetes who is nine weeks postpartum is not explicitly stated in the provided studies, but it can be inferred that a postpartum oral glucose tolerance test (OGTT) is necessary to assess the risk of developing type 2 diabetes mellitus (T2DM) 2, 3, 4, 5, 6.
• According to the studies, women with gestational diabetes mellitus (GDM) are at a high risk of developing T2DM, and the risk can be predicted by antepartum glucose tolerance test results 2, 4.
• The American Diabetes Association (ADA) criteria can be used to diagnose T2DM, and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria can be used to diagnose GDM 2.
• A study found that metformin therapy can be an effective and safe treatment for pregnant women with GDM, and it can improve postpartum OGTT results compared to insulin therapy 5.
• Another study suggested that an oral glucose tolerance test administered during the delivery hospitalization can be used to diagnose T2DM, and a normal result can exclude postpartum T2DM 6.

Timing of Follow-up

• The optimal timing of follow-up for women with GDM is not explicitly stated in the provided studies, but it is recommended to perform a postpartum OGTT at 4-12 weeks postpartum 6.
• One study found that an immediate postpartum OGTT can be useful in certain circumstances, such as when postpartum follow-up is challenging 6.
• Another study found that patients with early GDM are at a higher risk of postpartum dysglycemia, and postpartum follow-up and diabetes testing may be even more important to improve long-term health in these patients 3.

Predictors of Type 2 Diabetes

• Fasting blood glucose (FBG) and 2-hour OGTT plasma glucose can be used to predict the risk of developing T2DM in women with GDM 2, 4.
• The positive predictive value (PPV) of FBG and 2-hour OGTT plasma glucose can be used to estimate the probability of developing T2DM 2.
• A study found that the PPV of FBG suggests that if a woman tested positive for GDM, the probability of developing T2DM is approximately 24%, while the PPV of 2-hour OGTT plasma glucose suggests that the probability of developing T2DM is only 3% 2.