A medium close up front view of a group of women who are enjoying their pregnancies. They are all in their third trimester and are all looking into the camera holding their bumps as they stand in a community centre in the North East of England
Pregnancy is often described as a window into future health, but for many women, it may also be the first indication of lifelong cardiometabolic risk. This is the focus of current research by GP Dr. Ania Samarawickrama, whose PhD examines gestational diabetes and long-term metabolic risk among Australia’s increasingly diverse communities.
As Harmony Day approaches, the research raises an important question for general practice: are current screening approaches adequately reflecting the health realities of multicultural Australia? Gestational diabetes affects up to 20% of pregnancies in Australia, with rates exceeding 35% among South Asian women. Women who develop gestational diabetes also have a 10-fold increased lifetime risk of developing type 2 diabetes.
Challenges in Current Screening Practices
Despite the significant impact of gestational diabetes, much of the existing research informing clinical care has been conducted in populations that do not reflect Australia’s cultural diversity. Dr. Samarawickrama, a clinician epidemiologist based in Western Sydney, identified this gap in her everyday practice.
‘Patients were asking what gestational diabetes might mean for their long-term health and even for their children,’ she said. ‘But there was very little guidance about cardiometabolic risk across the life course, particularly for younger women and people from diverse communities.’
Her research focuses on understanding lifestyle risk factors, health patterns, and care pathways for women during pregnancy and beyond. The work draws on the PROMOTE cohort study, which is recruiting women in early pregnancy and following their health outcomes. Importantly, the cohort is highly diverse, with almost 80% of participants from CALD backgrounds, offering insights that are rarely captured in pregnancy research.
General Practice Perspective
The research brings a general practice perspective to gestational diabetes, an area traditionally led by hospital-based studies. By focusing on multicultural communities and the role of primary care across pregnancy and beyond, the project aims to strengthen understanding of gestational diabetes as a window into lifelong cardiometabolic health.
Dr. Samarawickrama’s research has already highlighted that standard clinical approaches may not always reflect these differences. For example, current referral criteria often rely on body mass index (BMI) thresholds. However, some populations, including South Asian women, can face elevated diabetes risk at lower BMI levels.
‘A generalist lens in how conditions are managed is so important,’ Dr. Samarawickrama said. ‘Pregnancy is a moment where we can identify risks that have implications for lifelong health.’
Postpartum Follow-Up Gaps
The research explores how lifestyle factors during pregnancy, including diet, physical activity, and mental health, influence gestational diabetes risk. But Dr. Samarawickrama notes one of the biggest gaps comes after birth. Fewer than half of women complete recommended follow-up testing after gestational diabetes.
‘There is currently no systematic national approach to follow up for women who have had gestational diabetes,’ she said. ‘General practice is uniquely placed to provide that continuity of care across the reproductive life course.’
Implications for Policy and Practice
As the only GP on the National Antenatal and Postnatal Guideline Leadership Group, Dr. Samarawickrama emphasizes the importance of ensuring a primary care perspective is represented in research and policy discussions. Ultimately, she hopes the work will lead to more inclusive prevention strategies, including improved screening, culturally appropriate advice, and better long-term follow-up.
‘I really think that interdisciplinary GP research has a lot of value,’ she said.
Dr. Samarawickrama has been awarded the 2026 PhD top-up scholarship from the Australian General Practice Research Foundation, the philanthropic arm of the RACGP, supporting GP-led research with real-world impact for patients and communities.
This development follows a growing recognition of the need for healthcare systems to adapt to the diverse needs of multicultural populations. As Australia continues to evolve, integrating culturally sensitive approaches into medical research and practice becomes increasingly crucial.
