The management of gestational diabetes mellitus after pregnancy

Gestational diabetes mellitus (GDM) is common, with an average prevalence in England and Wales of approximately 3.5%. It is associated with a 70% lifetime risk of developing type 2 diabetes mellitus (T2DM) for the women in the long term. It is therefore important to continue lifelong monitoring for abnormalities of glucose metabolism. There is a lack of international consensus on the best postpartum screening test, its timing, and the frequency and duration of long-term follow up after GDM. In general, screening rates are suboptimal across the globe with perhaps an optimistic trend in recent years with just over half of the women completing postpartum screening. Postpartum diabetes screening may detect T2DM and enable early treatment of hyperglycaemia, reducing the risk of adverse fetal outcomes in subsequent pregnancies and maternal microvascular complications. Screening can also identify women who might benefit from diabetes prevention interventions. Metformin has been shown to reduce the rate of diabetes development following delivery by 50% and should be considered in all cases of GDM if tolerated.