A strategy for the long-term postpartum monitoring of women with gestational diabetes: emphasizing secondary prevention

Background. Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, affecting, according to 2024 data, approximately 19.7% of pregnancies worldwide. GDM is not merely a transient condition but a marker of a lifelong high cardiometabolic risk for the woman. It is associated with the subsequent development of prediabetes, type 2 diabetes mellitus (T2DM), metabolic syndrome, and cardiovascular diseases. The high recurrence rate of GDM in subsequent pregnancies (up to 84%) and the progressive increase in T2DM risk over time underscore the critical importance of establishing an effective system for secondary prevention, starting from the early postpartum period. However, current clinical practice is often limited to a single examination 4-12 weeks after delivery, which is insufficient for the long-term management of the patient's health.

Objective. Using a clinical case example, to demonstrate the significance of long-term postpartum follow-up and the necessity of an active preventive strategy, including pharmacological intervention, in women with a history of GDM to prevent the development of carbohydrate metabolism disorders and cardiometabolic complications.

Materials and methods. This paper provides a detailed description of a clinical case of the 33 years old patient with GDM diagnosed at 26-27 weeks of gestation. Standard clinical and laboratory methods were used for pregnancy management and postpartum follow-up: a 75-g oral glucose tolerance test (OGTT), measurement of glycated hemoglobin (HbA1c) levels, self-monitoring of blood glucose, urinalysis with assessment of ketonuria, and fetal ultrasonography. During the postpartum period, an OGTT was used to assess carbohydrate metabolism.

Results. During pregnancy, despite diet therapy, the patient exhibited unstable glycemia with episodes of hyperglycemia and ketonuria, which necessitated the initiation of insulin therapy at 32-33 weeks. The pregnancy concluded with a term delivery without complications. An examination 14 months postpartum, following a 13% weight gain from baseline, revealed impaired glucose tolerance (fasting plasma glucose 5.9 mmol/L, 2-hour post-load plasma glucose 8.5 mmol/L). The patient was prescribed a extended-release formulation of metformin at a dose of 500 mg/day in addition to lifestyle modification recommendations.

Conclusion. The presented clinical case clearly illustrates that GDM is a predictor of early prediabetes development, even in the absence of abnormalities in the first weeks postpartum. The modern approach to managing patients with a history of GDM should evolve from episodic screening to a system of lifelong dynamic monitoring aimed at the early detection and correction of cardiometabolic risk factors. Lifestyle modification is the cornerstone of prevention; however, it may not be sufficient. The use of metformin in women with prediabetes and a history of GDM is a pathogenetically justified, effective, and safe strategy that not only reduces the risk of T2DM but also has a favorable impact on the lipid profile and cardiovascular health. The active integration of pharmacological prevention into clinical practice is essential for altering the long-term health trajectory of women.

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