The research, published in BMC Endocrine Disorders, was conducted by a team led by Etsegenet Yayut Munie and Melaku Taye Amogne of Addis Ababa University, working alongside collaborators at Monash University in Australia and Jimma University in Ethiopia. The investigators turned to Tikur Anbessa Specialized Hospital, a major urban tertiary referral center and university teaching hospital in Addis Ababa, to answer a deceptively simple question: among women diagnosed with gestational diabetes who delivered at the hospital, how many actually came back for postpartum diabetes screening within six months of giving birth? The answer, drawn from a careful retrospective review of medical records, was sobering.

The study design was methodical. The researchers identified 211 women who had been diagnosed with gestational diabetes and delivered at the hospital between January 2019 and January 2024, a five-year span that captured pre-pandemic and post-pandemic care alike. Using simple random sampling, they retrieved medical records from this cohort and abstracted the data with a standardized form, then analyzed everything in SPSS version 26. The primary outcome was straightforward: whether a woman completed a diabetes screening test within six months of delivery. The team also recorded postpartum glycemic status among those who were screened and used multivariable logistic regression to identify which factors independently predicted whether a woman would return for testing, reporting adjusted odds ratios with 95 percent confidence intervals.

The headline finding was that only 85 of the 211 women, or 40.3 percent, completed postpartum diabetes screening within the recommended six-month window. The women in the cohort had a mean age of 31.52 years, placing them squarely in the prime reproductive years, and yet the majority slipped through the follow-up net. In a setting where a tertiary referral hospital serves some of the best-resourced patients in the country, the authors note that screening uptake remained suboptimal even in this relatively favorable urban environment. If the best-connected patients in Ethiopia’s capital are missing follow-up testing at a rate of nearly 60 percent, the true national picture is likely worse.

What happened to the women who did return for testing adds urgency to the numbers. Among the 85 women screened, 20, or 23.5 percent, were diagnosed with type 2 diabetes at the time of testing, and another 20, also 23.5 percent, had prediabetes. Taken together, nearly half of the screened women had some form of dysglycemia, meaning abnormal blood glucose regulation, within months of giving birth. This is precisely the population in which early detection matters most: prediabetes can often be reversed with diet, physical activity, and weight management, while newly diagnosed type 2 diabetes in a young mother can be managed aggressively to protect her long-term health and her ability to care for her family.

The regression analysis revealed a clear pattern in who got screened and who did not. Women above 35 years of age were nearly five times more likely to complete postpartum screening than younger mothers, with an adjusted odds ratio of 4.97 and a 95 percent confidence interval of 1.54 to 16.0. Those who had a medical comorbidity during pregnancy, such as hypertension or another chronic condition compounding their gestational diabetes, had an adjusted odds ratio of 4.17, with a confidence interval of 1.80 to 9.68. The strongest single predictor was newborn birth weight: mothers whose babies weighed more than 4000 grams, a classic consequence of uncontrolled gestational diabetes, were more than eight times as likely to be screened, with an adjusted odds ratio of 8.63 and a confidence interval of 4.47 to 20.6.

Perhaps the most actionable finding concerned antenatal care. Women who attended eight or more antenatal care visits during pregnancy were almost six times more likely to return for postpartum diabetes screening, with an adjusted odds ratio of 5.98 and a 95 percent confidence interval of 2.52 to 14.19. This makes intuitive sense from a health-systems perspective: every antenatal visit is an opportunity for clinicians to explain why follow-up testing matters, to book the appointment before the woman leaves the hospital, and to build the trust and familiarity that bring patients back. The finding suggests that the postpartum screening gap is not primarily a problem of patient motivation but of missed opportunities during pregnancy and the immediate postpartum period, when contact with the health system is at its peak.

The biological logic behind postpartum screening is worth spelling out. Gestational diabetes arises when the hormonal environment of pregnancy, which includes placental hormones that antagonize insulin, overwhelms a woman’s pancreatic capacity to compensate. In most women, glucose tolerance normalizes after delivery, but the underlying vulnerability often does not. Longitudinal research worldwide has shown that women with prior gestational diabetes progress to type 2 diabetes at rates many times higher than the general female population, and the risk is highest in the first few years after delivery. The Ethiopian data, showing that nearly half of screened women already had abnormal glucose within six months, underscores how quickly that transition can occur and how little time there is to intervene.

The study’s implications reach well beyond one hospital in Addis Ababa. The International Diabetes Federation has documented the rising burden of diabetes across sub-Saharan Africa, where urbanization, changing diets, and declining physical activity are driving a quiet epidemic that intersects with maternal health. Gestational diabetes serves as an early warning system for this epidemic: every affected pregnancy identifies a woman at high risk who could benefit from years of preventive care. When screening uptake is only 40 percent, the health system loses most of that early-warning capacity, and women who could have been treated early instead present years later with established disease, complications, and higher costs for families and the public purse.

The authors are careful about what their retrospective, single-institution design can and cannot show. Chart reviews depend on the completeness of medical documentation, and the study reflects the experience of one urban tertiary center rather than the country as a whole, so the findings cannot simply be generalized to rural Ethiopia where access to care is far more limited. Still, the direction of the evidence is clear, and the research team calls for prospective studies to evaluate implementation strategies that could lift screening rates. The most promising approaches suggested by the antenatal care finding include embedding screening orders and reminders into routine postpartum care, using electronic medical records to flag women due for testing, and educating women during pregnancy about the lifelong importance of that single follow-up blood test. For the nearly 60 percent of women in this study who never got screened, and the undiagnosed cases of diabetes and prediabetes among them, such system-level fixes are not a luxury. They are the difference between catching a disease in time and missing it entirely.

Subject of Research: Postpartum diabetes screening uptake among women with prior gestational diabetes in Ethiopia

Article Title: Uptake of postpartum diabetes screening after gestational diabetes: a five-year institution-based retrospective study in Ethiopia

Article References: Munie, E. Y., Reja, A., Lim, S., Boyle, J., Arage, S., Mulisa, M. D., Wondie, E. M., Getachew, B., Gichamo, F. G., & Amogne, M. T. (2026). Uptake of postpartum diabetes screening after gestational diabetes: a five-year institution-based retrospective study in Ethiopia. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02626-y

Image Credits: AI Generated

DOI: 10.1186/s12902-026-02626-y

Keywords: gestational diabetes, postpartum screening, type 2 diabetes, prediabetes, Ethiopia, maternal health, antenatal care, screening uptake, dysglycemia, retrospective study, global health, endocrinology