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Call to expand screening of women previously diagnosed with gestational diabetes

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Women who have gestational diabetes during pregnancy have a higher than usual risk of developing type 2 diabetes, hypertension, and ischemic heart disease in the future, according to researchers.

As a result, they have called for the introduction of more follow-up screening for cardiovascular risk factors and better adherence to screening for type 2 diabetes, which is already recommended by the National Institute for Health and Care Excellence.

“The findings are the first to report on a large UK population and identify an at-risk group of relatively young women”

Krish Nirantharakumar

Their study looked at the incidence of type 2 diabetes, hypertension and ischemic heart and cerebrovascular diseases in more than 9,000 women previously diagnosed with gestational diabetes.

They found women diagnosed with gestational diabetes were over 20 times more likely to be diagnosed with type 2 diabetes later in life, over two and a half times more likely to develop ischemic heart disease and almost twice as likely to develop hypertension.

The study, led by the University of Birmingham, also included Warwick University, University Hospitals Birmingham NHS Foundation Trust and nurse researchers at Auckland University in New Zealand.

The findings, published in the journal PLOS Medicine, add insight on the development of type 2 diabetes, hypertension and cardiovascular disease in the early and latter post-partum periods.

Dr Krish Nirantharakumar, from Birmingham University, said: “The findings are the first to report on a large UK population and identify an at-risk group of relatively young women ideally suited for targeting risk factor management to improve long-term metabolic and cardiovascular outcomes.

“Women diagnosed with gestational diabetes were significantly more likely to develop hypertension and ischemic heart disease at a relatively young age,” he said. “The risk was greatest for type 2 diabetes in the first year following diagnosis of gestational diabetes and persisted throughout the follow-up period.”

“Guidelines need to include post-partum screening and management for all cardiovascular risk factors”

Barbara Daly

Current NICE guidelines, published in 2015 and due for review in 2019, recommend annual diabetes screening for women previously diagnosed with gestational diabetes. However, the study also found that follow-up checks for both diabetes and other cardiovascular risk factors was low.

With the exception of blood pressure, less than 60% of women were screened in the first year after giving birth and decreased to less than 40% by the second year after giving birth, said researchers.

Dr Barbara Daly, a nurse researcher from the University of Auckland, said the research was especially important given that the prevalence of gestational diabetes was increasing rapidly in most developed countries.

She said: “Guideline recommendations for screening and management of hypertension, lipids and smoking cessation are lacking and need to be reviewed.

“This study found follow-up screening was poor for type 2 diabetes and other cardiovascular risk factors such as hypertension,” warned Dr Daly.

“Clinical guidelines need to include post-partum screening and management for all cardiovascular risk factors in women diagnosed with gestational diabetes and not restrict it to diabetes,” she added. 

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