Abstract
Background:
Gestational diabetes mellitus (GDM) significantly increases the risk of developing type 2 diabetes mellitus (T2DM) in later life. Postpartum follow-up screening plays a vital role in early detection and prevention, yet uptake remains low in many regions of India, including Telangana.
Objectives:
To assess the perception toward postpartum diabetes screening among women with prior GDM and to estimate the proportion of women who underwent timely follow-up testing.
Methods:
A cross-sectional mixed-method study was conducted among 90 GDM-diagnosed women from two public tertiary hospitals in the Warangal district. Data were collected through a structured telephonic questionnaire and analyzed using descriptive statistics and logistic regression. In-depth interviews with six healthcare providers were conducted to explore system-level insights.
Results:
Although 85.56% of participants underwent blood sugar testing postpartum, only 53.33% did so after discharge, and just 40% met the recommended ≥6-week follow-up timeline. Home-based testing was most common (47.92%), and only 4.17% utilized public health facilities. Women advised by doctors were significantly more likely to perceive screening as necessary (OR: 33.2, P = 0.001).
Conclusion:
There is a pressing need to strengthen postpartum diabetes follow-up through improved provider counseling, structured recall systems, and community health worker involvement.
KEYWORDS: Follow-up, gestational diabetes mellitus, India, perception, postpartum screening, public health, type 2 diabetes
INTRODUCTION
Gestational diabetes mellitus (GDM) is a common medical condition complicating pregnancies, characterized by glucose intolerance with onset or first recognition during gestation. Its prevalence is increasing globally, particularly in low- and middle-income countries such as India, where the burden of diabetes is second only to China, with over 77 million affected adults.[1,2] Women with GDM are at a significantly elevated risk of developing type 2 diabetes mellitus (T2DM) later in life, with studies reporting postnatal diabetes progression rates ranging from 3% to 70%.[3,4] Postpartum screening plays a pivotal role in early detection and prevention of T2DM, yet compliance remains low despite established guidelines.[5]
MATERIALS AND METHODS
A cross-sectional, mixed-method study was conducted from June to August 2020 in two public tertiary hospitals of the Warangal district, Telangana. The study included 90 women previously diagnosed with GDM who had delivered at least six weeks prior but not more than a year before the survey. Purposive sampling was used to identify eligible participants. Data were collected via a structured, pre-tested telephonic questionnaire that included both closed- and open-ended questions, administered in the local language. Quantitative data were analyzed using STATA, with descriptive statistics and logistic regression applied to identify factors influencing perception toward postpartum screening. Additionally, in-depth interviews were conducted with six healthcare providers to explore their perspectives on postpartum diabetes screening practices. Thematic analysis was used for qualitative data.
RESULTS
The majority of respondents (85.56%) reported that they underwent blood sugar testing at some point after delivery. However, only 53.33% had this testing done after discharge, which is the appropriate time frame for postpartum follow-up. A small percentage (6.67%) had not undergone any testing, while 7.78% were unsure if testing had occurred [Table 1].
Table 1.
Postpartum screening status among 90 respondents
| Response | n (%) | |
|---|---|---|
| Yes | 77 (85.56) | |
| No | 6 (6.67) | |
| Don’t know | 7 (7.78) | |
| Total | 90 (100) |
Among women aged 21–30 years, only about 52.7% believed that follow-up blood glucose testing after delivery was necessary. In contrast, 81.25% of women aged 31–40 years agreed with the need for postpartum screening, indicating that age may influence health awareness. Overall, 57.77% of the 90 respondents perceived postpartum screening as necessary [Table 2].
Table 2.
Perception on follow-up testing by age group
| Age group | Necessary (%) | Not necessary (%) | Total respondents | |||
|---|---|---|---|---|---|---|
| 21–30 | 39 (52.7) | 35 (47.29) | 74 | |||
| 31–40 | 13 (81.25) | 3 (18.75) | 16 | |||
| Total | 52 (57.77) | 38 (42.22) | 90 |
Logistic regression analysis showed that women who underwent testing ≥6 weeks postpartum were significantly more likely to understand the necessity of follow-up, with an adjusted odds ratio (AOR) of 0.05 (P = 0.000), indicating a strong inverse association. Receiving doctor’s advice emerged as the most influential factor, with an AOR of 33.2 (P = 0.001), underscoring the pivotal role of healthcare communication. Other variables like age and education were not statistically significant in the final model. These findings highlight that provider interaction and timely testing are key drivers of perception regarding postpartum diabetes screening [Table 3].
Table 3.
Logistic regression summary for factors affecting perception
| Variable | Adjusted odds ratio | 95% CI (lower–upper) | P | |||
|---|---|---|---|---|---|---|
| Underwent testing ≥6 weeks | 0.05 | 0.01–0.25 | 0.000 | |||
| Doctor’s advice received | 33.2 | 4.14–267.1 | 0.001 |
Among 90 women diagnosed with GDM, 85.56% reported undergoing some form of blood glucose testing after delivery. However, only 53.33% had testing done post-discharge, and just 40% followed the recommended testing timeline of 6 weeks or later. Nearly half (47.9%) relied on home glucometer testing, while only 4.17% used public hospital facilities. These findings reveal that although initial testing rates appear promising, adherence to optimal timing and clinical settings for screening remains poor, highlighting the need for better system-level follow-up mechanisms [Table 4].
Table 4.
Postpartum diabetes mellitus screening profile of the 90 respondents
| Variable | Category | n (%) | ||
|---|---|---|---|---|
| Underwent blood test after delivery | Yes | 77 (85.56) | ||
| No | 6 (6.67) | |||
| Don’t know | 7 (7.78) | |||
| Blood test after discharge | Yes | 48 (53.33) | ||
| No | 42 (46.67) | |||
| Timing of blood test | Not tested or <6 weeks | 54 (60) | ||
| Tested ≥6 weeks after delivery | 36 (40) | |||
| Facility used for testing | Public hospital | 2 (4.17) | ||
| Private hospital | 17 (35.42) | |||
| Diagnostic center (self-referred) | 6 (12.50) | |||
| Home (Glucometer) | 23 (47.92) |
DISCUSSION
This study assessed the perceptions and practices related to postpartum follow-up screening among women diagnosed with GDM in the Warangal district, Telangana. While 85.56% of respondents reported undergoing blood sugar testing after delivery, only 53.33% had the test after hospital discharge, and just 40% adhered to the recommended 6-week postpartum testing window. These findings are consistent with global reports indicating poor uptake of postpartum screening, despite clinical guidelines emphasizing its importance in preventing the progression to T2DM.[6]
The International Diabetes Federation estimates that 16.2% of women with live births globally have some form of hyperglycemia in pregnancy, and 85% of these are attributed to GDM.[6] Studies have shown that up to 60% of women with a history of GDM develop T2DM later in life, especially within 5 to 10 years postpartum.[7,8] This underscores the critical window of opportunity for postpartum follow-up offers in identifying and mitigating long-term metabolic risk.
Despite this, multiple Indian studies have reported suboptimal postpartum screening rates. In Kerala, only 29% of GDM women underwent follow-up testing, while similar patterns were reported in Tamil Nadu and Haryana, with variations in prevalence ranging from 7.1% to 27%.[9,10] These regional disparities reflect not just variability in clinical practice, but also differences in patient awareness, accessibility of testing services, and effectiveness of public health messaging.
In the present study, receiving advice from healthcare professionals significantly influenced women’s perception and screening compliance. Those who were advised by doctors had 33 times higher odds of perceiving follow-up as necessary, suggesting that provider-patient communication plays a pivotal role in shaping health behavior.[11] However, only 4.17% of women utilized public hospitals for screening, indicating potential mistrust or logistical barriers in public health infrastructure.[12]
CONCLUSION
Strengthening health system initiatives, including structured recall mechanisms and community-based follow-up, is essential. Improving awareness about the long-term risk of type 2 diabetes and ensuring access to standardized testing methods can help mitigate future disease burden in this high-risk population.
Ethical clearance
Ethical clearance was obtained for the study.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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