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Who’s responsible for the care of women during and after a pregnancy affected by gestational diabetes?

Gestational diabetes mellitus (GDM) is the strongest single population predictor of type 2 diabetes,1 and current Australian prevalence is 10%–13%, depending on the criteria used.2 Poor health outcomes extend to children of mothers who had GDM, due to increased risk of obesity and abnormal glucose metabolism during childhood, adolescence and adulthood.3

Antenatal lifestyle intervention is shown to improve short- and long-term maternal and infant health outcomes.3 In addition, it can effectively prevent type 2 diabetes among women who have had GDM.1 However, although some centres of excellence exist, in many cases, antenatal care is not delivered systematically.4

After their babies are born, women who have had GDM can be described as falling into a health care “chasm”.5 When these women leave hospital, their obstetricians and endocrinologists feel that their work is done. Lack of coordination between the hospital and primary care sectors can mean that no one assumes responsibility for the care of these women.

The opportunity to prevent or delay type 2 diabetes in this high-risk population through primary care was noted more than a decade ago.6