POSTPARTUM SCREENING STRATEGIES AND CARDIOMETABOLIC PREVENTION AFTER GESTATIONAL DIABETES

Abstract

DOI: https://doi.org/10.46296/yc.v10i18.0857

Abstract

Women with prior gestational diabetes are at high risk of developing type 2 diabetes and cardiovascular disease in the years after delivery, making the postpartum period a critical window for metabolic screening and cardiometabolic prevention. This critical review synthesizes evidence published between 2015 and 2025 on interventions designed to increase completion of the 75 g oral glucose tolerance test postpartum and to strengthen continuity of follow-up care. Clinical studies, meta-analyses, and relevant guidelines were included, with emphasis on strategies feasible in real-world Latin American settings. Overall, postpartum screening rates remain low (<50%) and are driven by multilevel barriers: patient-level factors (time constraints, competing newborn-care demands, low risk perception, and logistical challenges of a 2-hour test), provider-level factors (insufficient recommendation, education, or organized follow-up), and system-level gaps (fragmented care transitions and poor longitudinal continuity). Evidence indicates that antenatal education—particularly group-based formats—is among the most effective approaches to improve screening uptake, followed by individualized education. Telephone reminders tend to outperform isolated SMS reminders, and access-facilitating approaches (advance scheduling, integration of obstetric care with primary care or endocrinology) improve both screening completion and early detection of prediabetes. Digital health interventions (tailored messaging, smartphone apps) are feasible and acceptable, but their impact is often modest when implemented as standalone measures. Overall, multicomponent strategies combining education, reminders, and care navigation/coordination achieve the most sustained improvements in screening and prevention. The review concludes that an integrated, scalable model is needed—one that starts education during pregnancy, reduces logistical friction around screening, ensures effective transition to primary care, and maintains follow-up for at least 3 years postpartum—leveraging existing maternal-child health infrastructure and widely available mobile technology across the region.

Keywords: gestational diabetes; postpartum screening; type 2 diabetes; prevention; primary care; Latin America.