Postpartum glucose follow-up after gestational diabetes in China: provider and institutional determinants in a multicenter survey across urban public hospitals.

BACKGROUND

Postpartum glucose follow-up after gestational diabetes mellitus (GDM) represents an important opportunity for early diabetes risk identification and long-term type 2 diabetes prevention. Obstetric healthcare professionals play a key role in initiating postpartum follow-up, yet evidence on provider- and institution-related factors influencing implementation in routine obstetric care remains limited.

METHODS

A multicenter cross-sectional survey was conducted among 638 obstetric healthcare professionals from 128 participating urban public hospitals across 15 provinces in China. A self-developed questionnaire was refined through two rounds of Delphi expert consultation and evaluated using exploratory factor analysis. Data were analysed using descriptive statistics, Pearson's correlation analysis, Mann-Whitney U tests, Kruskal-Wallis H tests, and robust regression based on a generalised linear model.

RESULTS

Mean scores for knowledge, professional beliefs, and practice were 4.07 ± 0.57, 3.99 ± 0.40, and 3.89 ± 0.73, respectively, indicating that practice lagged behind knowledge and professional beliefs. Knowledge was positively correlated with professional beliefs (r = 0.473, P < 0.001) and practice (r = 0.630, P < 0.001). Participation in specialised GDM training, experience working in a specialist GDM clinic, and self-reported mastery of relevant knowledge were associated with higher scores across domains. Hospital-level differences were observed for practice scores, but these differences did not indicate a simple gradient by hospital level.

CONCLUSION

This study suggests that implementation of postpartum glucose follow-up after GDM in routine obstetric care is associated with both provider- and institution-related factors. Although obstetric healthcare professionals generally demonstrated good knowledge and positive professional beliefs, practice remained comparatively weaker. Specialised training, clinical experience, and institutional context were associated with implementation-related practice. Future efforts to strengthen training, optimise follow-up pathways, and improve institutional support may help reduce missed opportunities for postpartum follow-up and strengthen long-term diabetes prevention after GDM.