Analysis of medication adherence and influencing factors in postpartum patients with persistent hyperglycemia following gestational diabetes mellitus

This retrospective cohort study aimed to investigate medication behavior and associated influencing factors among patients with gestational diabetes mellitus (GDM) who developed abnormal glucose metabolism during the postpartum period, with the goal of informing the development of a patient-centered postpartum glucose management model. We included patients diagnosed with GDM who delivered at Nanjing Drum Tower Hospital between January 1, 2020, and December 31, 2022. Using a combination of semi-structured telephone interviews and structured questionnaires, we retrospectively collected and analyzed data related to postpartum medication behaviors and factors affecting treatment initiation. Among the 274 participants, 80 received pharmacological intervention and 194 did not. In the pharmacotherapy group, the average interval from delivery to initiation of medication was 12.3 ± 6.6 months, with monotherapy being the most common regimen (72.5% metformin). Telephone interviews revealed generally low medication adherence and overall dissatisfaction with current postpartum glucose management. Multivariate analysis identified the following factors associated with initiation of pharmacological treatment: impaired fasting glucose combined with impaired glucose tolerance (IFG + IGT), dyslipidemia, use of hypoglycemic agents during pregnancy, and higher perceived diabetes risk (OR > 1, p < 0.05). Conversely, elevated HbA1c levels, breastfeeding beyond one year, and higher self-efficacy were associated with reduced likelihood of medication intervention (OR < 1, p < 0.05). Postpartum glycemic management remains suboptimal in patients with persistent hyperglycemia after GDM. Identified barriers to pharmacotherapy—including delayed initiation and misalignment with postpartum daily life—highlight the need for more adaptable and personalized management models to improve long-term medication adherence and outcomes. This study has been publicly registered in the Chinese Clinical Trial Registry (ChiCTR) (registration no. ChiCTR2300074444, registration date:2023/08/07, retrospectively registered).