Screeningul diabetului post-partum după diabetul gestațional: alegerea testului și continuitatea îngrijirii – o analiză narativă

Introduction

Gestational diabetes mellitus (GDM) is a marker of future metabolic disease. The 2026 American Diabetes Association (ADA) standards estimate a 50-60% lifetime maternal risk of diabetes after GDM and approximately tenfold higher type 2 diabetes risk than in women without GDM⁽¹⁾. Postpartum screening offers an opportunity to identify persistent dysglycemia and connect women to prevention.

Postpartum glucose screening frequently remains below 50%⁽²⁾. Recovery, newborn care, fasting, transportation and fragmented responsibility can reduce attendance^(3-6). A comprehensive test that is never performed cannot deliver its intended diagnostic benefit.

Materials and method: literature search and evidence selection

This narrative review draws on targeted searches and source checks of PubMed-indexed records, professional-society guidance and publisher websites, updated on 8 September 2026. Search concepts included gestational diabetes, postpartum screening, oral glucose tolerance testing, fasting glucose, HbA1c, inpatient testing and primary care transition. Guidelines, diagnostic studies, trials, systematic reviews and implementation studies were selected for clinical relevance. Selection was purposive, without a registered protocol, duplicate screening or formal risk-of-bias assessment; the review is not exhaustive. Where full text was unavailable, interpretation was restricted to accessible abstracts or source records.

Test selection and timing after gestational diabetes

Professional guidance varies in its balance between diagnostic coverage and feasibility. A review of 26 clinical practice guidelines documented substantial heterogeneity and evidence gaps⁽⁷⁾. Table 1 compares major approaches, and Table 2 summarizes test characteristics.

ADA recommends a fasting 75-g oral glucose tolerance test (OGTT) at 4-12 weeks postpartum using nonpregnancy criteria. OGTT detects both fasting and post-load abnormalities, being preferred to glycated hemoglobin (HbA1c), which can be distorted by red-cell turnover, delivery blood loss and preceding pregnancy glycemia⁽¹⁾.

NICE recommends checking glucose before transfer to community care to exclude persistent hyperglycemia. When glucose normalizes after birth, it recommends fasting plasma glucose (FPG) at 6-13 weeks; after 13 weeks, FPG or HbA1c if fasting testing is impractical. Routine OGTT is not recommended⁽⁸⁾. This simpler strategy sacrifices some diagnostic coverage.

In a retrospective cohort of 1961 women with GDM, 1090 returned for postpartum OGTT. FPG≥6.1 mmol/L identified 76 of 167 women with impaired two-hour glucose tolerance (sensitivity 45.5%); 91 of 968 women with normal fasting glucose (9.4%) had impaired two-hour glucose tolerance⁽⁹⁾. These threshold-dependent findings illustrate what fasting-only testing can miss.

In a national retrospective analysis, 677 of 9118 women with GDM had both postpartum HbA1c and OGTT results; overall correlation with two-hour glucose was weak (r=0.21)⁽¹⁰⁾. Selected participants and heterogeneous timing limit interpretation. HbA1c may provide supplementary information, but it should not be presented as an equivalent early substitute for OGTT⁽¹⁾.

Testing before discharge: benefits
and limitations

The 2024 American College of Obstetricians and Gynecologists (ACOG) update considers inpatient 75-g OGTT a reasonable alternative to outpatient testing⁽¹¹⁾. Testing within an existing admission reduces the need for a separate visit and allows results to enter the discharge plan.

A systematic review of seven cohort studies involving 2254 women found lower noncompletion with inpatient testing than with testing at 4-12 weeks, although heterogeneity was substantial⁽¹²⁾. Implementation cohorts likewise support the feasibility of inpatient OGTT⁽¹³⁾. These observational findings support improved engagement without establishing diagnostic equivalence.

Higher completion does not demonstrate diagnostic equivalence. In a pooled patient-level analysis, a normal immediate OGTT was reassuring for later absence of overt diabetes, but some women changed glucose-tolerance category⁽¹⁴⁾.

Authors’ summary of guidance^(1,8,11). ADA – American Diabetes Association; ACOG – American College of Obstetricians and Gynecologists; FPG – fasting plasma glucose; HbA1c – glycated hemoglobin; OGTT – oral glucose tolerance test.

Authors’ synthesis^(1,9,10). FPG – fasting plasma glucose; HbA1c – glycated hemoglobin; OGTT – oral glucose tolerance test.

A 2026 retrospective cohort found that glucose classification varied with testing day and diagnostic criteria⁽¹⁵⁾. Its observational design does not establish a universal optimal inpatient day. Very early results therefore need interpretation in the context of rapidly changing postpartum physiology.

Inpatient testing should be understood as an engagement strategy, while ADA retains 4-12-week OGTT as its reference approach⁽¹⁾. Neither a normal inpatient result, nor a normal later result eliminates the need for continuing surveillance.

Continuity of care: from postpartum testing to long-term prevention

Qualitative studies identify uncertainty about the purpose of testing and incomplete handover between prenatal, obstetric and primary care teams^(3,4). These findings support explicit responsibility for the next clinical action.

A network meta-analysis found heterogeneous benefits from education, flexible testing and multimodal strategies⁽⁵⁾. Conversely, a primary care electronic reminder trial did not significantly improve screening⁽⁶⁾. Reminders may support care coordination, but their effectiveness cannot be assumed in isolation.

A randomized trial of default primary care scheduling plus tailored messages increased visit completion within four months of the estimated due date from 22% to 40%⁽¹⁶⁾. It included several chronic risk groups, so it supports transition design rather than GDM-specific screening efficacy. An enhanced referral pathway and a mother-infant program also reported improved engagement^(17,18).

After a normal initial test, ADA recommends lifelong screening every 1-3 years; NICE recommends annual HbA1c testing^(1,8). Reminder programs demonstrate feasibility but continuing attrition⁽¹⁹⁾.

Surveillance should lead to prevention. In the Diabetes Prevention Program Outcomes Study, lifestyle intervention and metformin reduced diabetes progression among women with previous GDM and impaired glucose tolerance⁽²⁰⁾. A 2025 meta-analysis estimated a 19% relative reduction with postpartum lifestyle intervention after excluding trials at high risk of bias⁽²¹⁾. Another review found low or very low certainty for several self-care outcomes⁽²²⁾. Programs should reflect individual risk and local resources.

Discussion and clinical synthesis

Obstetric teams don’t need to provide lifelong diabetes care. They should make the diagnosis visible, initiate the first assessment and transfer a documented follow-up plan to a clinician who accepts responsibility for prevention.

Limitations include purposive source selection, variable guideline quality, heterogeneous diagnostic timing and criteria, along with context-specific implementation studies⁽⁷⁾. No pooled analysis or formal evidence grading was undertaken. Findings from other health systems require local evaluation before application in Romania.

Author-proposed practical pathway (unvalidated synthesis)

This author-proposed pathway synthesizes the evidence discussed above. It has not been prospectively validated, and it is not a professional-society recommendation.

• Document GDM in the discharge summary and explain the future metabolic risk.
• Name the clinician responsible for the initial test, choose timing according to the applicable guideline, and arrange testing before discharge where feasible.
• Assign result review and direct communication to a named clinician or team.
• Apply nonpregnancy diagnostic criteria, and confirm diabetes when required. A single diabetes-range value without unequivocal hyperglycemia requires confirmation; symptomatic or marked hyperglycemia warrants prompt assessment⁽¹⁾.
• Transfer the GDM history, test date and result, risk category, surveillance interval and prevention plan to the receiving clinician.
• Arrange long-term recall, including after normal results, and document who will provide surveillance.

Conclusions

Postpartum screening after gestational diabetes mellitus should connect an appropriate test with reliable result review and continuing prevention. The American Diabetes Association favors OGTT at 4-12 weeks; NICE favors a simpler fasting strategy. Inpatient testing can reduce missed opportunities, but the interpretation requires attention to timing. Clear ownership and documented handover are essential to translate screening into sustained care.

Ethics, consent and data availability: not applicable. This review used published literature and involved no new participants or datasets.

Acknowledgements and generative AI disclosure: OpenAI ChatGPT (GPT-5.6 Sol, as recorded during initial preparation; ChatGPT/Codex for subsequent revision) assisted literature-search organization, drafting, language editing and formatting. No original patient data, experimental results or statistical analyses were generated. The authors retain responsibility for source verification, interpretation and the final manuscript.

Conflict of interest: The authors declare no conflicts of interest related to this manuscript.

Financial support: This review received no specific funding.

Author contributions: E.C.M. – conceptualization, methodology, literature search, evidence synthesis, writing–original draft, and project administration. A.M.M. – methodology, interpretation, and writing-review and editing. D.S., R.V.S. and D.N. – methodology, supervision, validation and writing-review and editing. All authors: final approval of the manuscript and accountability for the work.

Corresponding author: Eduard-Cristian Mihoci E-mail: eduard_mihoci@yahoo.com

Conflict of interests: none declared.

Financial support: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.