Preventive care for gestational diabetes: gaps in maternity care across four European countries

Background

Gestational diabetes mellitus (GDM) is an increasing public health concern. Early pregnancy care for women at high-risk, including health behavioural interventions is essential for supporting healthy gestational weight gain, preventing and managing GDM and improving maternal outcomes. This study examined availability, delivery and organisational capacity for preventive care within maternity services.

Methods

A mixed-methods study was conducted among health professionals in Spain, Poland, Norway, and Ireland. Data were collected from one maternity hospital per country with additional primary care settings in Spain and Norway. A cross-sectional survey (n = 147) assessed availability and organisational capacity for preventive care. Semi-structured interviews (n = 17) explored experiences of delivering care to women at risk of GDM. Survey data were analysed descriptively and qualitative data thematically.

Results

The availability of preventive care varied across countries. Routine weight monitoring during pregnancy was widely reported in Spain (94%) and Poland (87%). More comprehensive services, including dietitian referral, group education and digital tools were more frequently reported in Ireland (60-93%). Respondents from Norway reported low availability across all preventive services (2-38%). Interviews identified inconsistencies in service delivery. Women at risk of GDM were identified early; however, care was predominantly focused on screening and diagnosis. Preventive care was often limited to women with specific risk factors such as severe obesity or previous GDM. Organisational barriers included limited consultation time, lack of educational resources for women and insufficient integration of preventive care into clinical pathways.

Conclusions

Strengthening organisational capacity and better integrating preventive interventions into routine maternity pathways are essential to enable early action and reduce GDM-related adverse outcomes.

Key messages

• Early identification of GDM risk rarely leads to preventive care, as services focus on screening and diagnosis.

• Integrating preventive care into routine maternity care is essential for timely intervention for women at risk of GDM.