As a personal trainer who “lived and breathed” a healthy lifestyle, it was a “huge shock” for Jenna Smith to learn she had gestational diabetes during her third pregnancy.

The pre- and postnatal trainer for online fitness business She Moves had no risk factors.

Even her midwife was shocked, and now she wants to raise awareness and help break the stigma around gestational diabetes.

“A lot of women think it’s so closely related to lifestyle, but in actual fact it opened my eyes that anyone who has a placenta is at risk of getting it,” Smith said.

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Gestational diabetes is a form of high blood sugar affecting pregnant women.

Women with gestational diabetes are seven times more likely to develop type 2 diabetes than those without, yet over a 10-year period only half of these women were tested for diabetes within six months of giving birth, a new University of Otago study has found.

Anonymised data from the Ministry of Health’s National Collections was used to identify 14,443 women who had gestational diabetes for the first time between 2005 and 2015.

Of those women, 41% (5903) had a recommended test for type 2 diabetes within three months of giving birth, 53% (7699) within six months, and 61% (8814) within 12 months.

Smith said she was “one of the lucky ones” after being reminded and encouraged by her midwife and doctor to get follow-up testing.

Guidelines from the Ministry of Health recommend all women with gestational diabetes receive a blood test for type 2 diabetes at three months postpartum, then yearly.

After failing the first standard glucose test at 28 weeks pregnant, Smith went back for follow-up testing and found out she had gestational diabetes.

“I’m thankful that I did go for the standard testing during pregnancy and that it was picked up.

“It was a huge shock. It took me a while to wrap my head around it. With my job, everything I do is living and breathing health and exercise and I have no real risk factors.”

Once she did wrap her head around it, Smith said she was “willing to do anything” to keep her and her baby safe.

After being diagnosed, she was put under the regional diabetes clinic and had a dietician and nurse monitoring her.

“I had to keep a food diary, test blood sugars before and after every meal – so, six to seven times a day – then check in every week with the nurse and dietician.”

Dr Andrew Sise, lead author of the postpartum diabetes testing study, said the number of women being tested was much lower than researchers had hoped for.

“The results show that opportunities to protect the health of women with gestational diabetes through early detection and diagnosis of type 2 diabetes are being missed.”

The study, published in Diabetes Research and Clinical Practice, also revealed ethnic and regional disparities.

Only 35% of Māori women received a recommended test by six months postpartum.

“We know that there are already major inequities in provision of healthcare between Māori and non-Māori in New Zealand. This adds to that picture, and it needs to be improved,” Sise said.

Regionally, testing rates ranged from less than 20% in some areas of Aotearoa to more than 60% in others.

“It’s worrisome that if you lived in some places you’d have had a very low chance of receiving a test. Ideally, everywhere would have a high rate of testing,” Sise said.

Left undiagnosed and untreated, type 2 diabetes can cause long-term health issues such as kidney disease, visual impairments, heart attacks, strokes, and problems with circulation.

“My risk of developing diabetes later on in life has definitely increased, so I have been advised every year at my son’s birthday to have that test re-done every year for the rest of my life,” Smith said.

“Not going to lie, it was all very full on, super-overwhelming to begin with, but to take care of my baby I was willing to do it all.”