What follow-up care is necessary for women who have had gestational diabetes after delivery?

For women who have had gestational diabetes, specific follow-up care is necessary after delivery:

• Immediate Post-Delivery Care:
  • Women diagnosed with gestational diabetes should stop blood glucose-lowering therapy immediately after birth ¹.
  • Before women are transferred to community care, their blood glucose should be tested to exclude persisting hyperglycaemia ¹.
• Early Postnatal Follow-Up (6-13 weeks):
  • Women should be offered lifestyle advice, including weight control, diet, and exercise ¹.
  • A fasting plasma glucose test should be offered 6 to 13 weeks after the birth to exclude diabetes, which may take place at the 6-week postnatal check ¹,².
  • If a fasting plasma glucose test has not been done earlier, or if it is not possible, an HbA1c test should be offered after 13 weeks ¹,².
  • A 75-g 2-hour oral glucose tolerance test (OGTT) should not be routinely offered ¹.
• Interpreting Test Results and Ongoing Management:
  • If the fasting plasma glucose level is below 6.0 mmol/litre (or the postnatal test is negative): Advise the woman that she has a low probability of having diabetes at the moment ¹. She should continue to follow lifestyle advice ¹. She will need an annual test, such as an HbA1c, to check that her blood glucose levels are normal ¹,². Advise her that she has a moderate risk of developing type 2 diabetes and offer advice and guidance in line with the NICE guideline on preventing type 2 diabetes ¹,².
  • If the fasting plasma glucose level is between 6.0 mmol/litre and 6.9 mmol/litre (or non-diabetic hyperglycaemia is diagnosed): Advise the woman that she is at high risk of developing type 2 diabetes ¹,². Offer her advice, guidance, and interventions in line with the NICE guideline on preventing type 2 diabetes ¹. Offer a referral into the NHS Diabetes Prevention Programme if eligible ¹,².
  • If the postnatal test suggests a diagnosis of diabetes: Arrange repeat testing and ongoing management as appropriate ².
• Future Pregnancy Planning and General Advice:
  • Remind women of the symptoms of hyperglycaemia ¹.
  • Explain the risks of recurrence in future pregnancies and offer diabetes testing when planning future pregnancies ¹.
  • Remind women of the importance of contraception and the need for preconception care when planning future pregnancies ¹,².