"You Had Gestational Diabetes." Now What?

Objective: To describe an intervention to increase postpartum check-ups among mothers with gestational diabetes.

Methods: Approximately 1,500 Utah births are affected by gestational diabetes mellitus (GDM) annually. Postpartum check-ups provide physicians the opportunity to counsel mothers about preventing overt diabetes and to screen for previously undiagnosed type 2 diabetes. Too often, mothers with GDM do not appear for postpartum check-ups. This may be especially problematic for Medicaid-covered births, as prenatal Medicaid ends two months postpartum.  Moreover, some physicians may not even recognize the importance of postpartum checkups. The Utah Gestational Diabetes Collaborative has developed a packet to send to all women who had a diagnosis of GDM on the birth certificate.  The packet includes: 1) a card describing the long-term risks associated with GDM stressing the importance of a postpartum check-up that includes a glucose test and 2) a magnet with tips for lifestyle changes to prevent type 2 diabetes.  In addition, Continuing Education Credits were offered for a statewide telehealth broadcast in October 2009 by a perinatologist with expertise in GDM.

Results:More than 100 Utah health professionals attended the telehealth broadcast. Related changes in practice will be assessed in January, 2010.  Mailings will be sent monthly to women identified with GDM two months postpartum to encourage making and keeping a postpartum appointment.

Conclusion: New mothers who had GDM but do not obtain postpartum check-ups experience a missed opportunity for primary prevention of diabetes as well as for testing for undiagnosed diabetes.  More emphasis needs to be placed on this important visit.