Enhancing long-term health: the need for continuity of care of post-partum women in reducing the burden of diabetes mellitus and improving child health in a low middle-income country

This study aimed to determine the prevalence and recurrence of hyperglycaemia in pregnancy (HIP), including gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM), among multigravida women in Sri Lanka. We also sought to identify the associated risk factors and explore public health strategies to mitigate HIP and its progression to T2DM. Design: This was a hospital-based study with combined cross-sectional and retrospective cohort components. Setting: The study was conducted across three tertiary care hospitals in the Western Province and one intermediate obstetric care facility in the Southern Province of Sri Lanka. Participants: A total of 782 multigravida pregnant women with documented outcomes from previous pregnancies were included. The selection criteria required comprehensive data on past and current hyperglycaemic status, therefore if a participant had an incomplete medical record or undocumented glycaemic outcome, that record was excluded and incomplete records were not included to the study cohort. Complete case analysis was applied for all primary and secondary outcome analyses. Primary and secondary outcome measures: The Prevalence of HIP, GDM recurrence, and progression to T2DM were assessed. Risk factors such as maternal age, obesity, family history of diabetes, and prior GDM were analysed using multinomial firth-type penalized logistic regression. The prevalence of HIP in the cohort was 21.2% (95% CI: 18.4–24.3%), with 16.9% diagnosed with GDM and 4.3% diagnosed with T2DM. GDM recurred in 78.2% of women with prior GDM, whereas 5.5% of women without prior GDM developed the condition. In the firth-type penalized multinomial logistic regression, a history of GDM in a past pregnancy was associated with current T2DM (aOR 25.64). Increasing age and family history of DM were significant risk factors for both outcomes, while obesity significantly increased the odds of GDM (aOR: 2.05). The findings underscore the need for robust postpartum and interpregnancy care to prevent the progression of GDM to T2DM and improve maternal and child health outcomes. Public health strategies, such as universal screening, risk stratification, and tailored interventions, are essential for mitigating HIP in low- and middle-income countries.