Is screening reflecting the realities of multicultural Australia?

Pregnancy is often described as a window into future health, but for many women, it may also be the first sign of lifelong cardiometabolic risk.
 
That is the focus of current research by GP Dr Ania Samarawickrama, whose PhD is examining 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 around 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.
 
Yet 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, says that gap became obvious to her in 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.
 
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.’
 
The research explores how lifestyle factors during pregnancy, including diet, physical activity and mental health, influence gestational diabetes risk.
 
But Dr Samarawickrama says 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.’
 
As the only GP on the National Antenatal and Postnatal Guideline Leadership Group, Dr Samarawickrama says ensuring a primary care perspective is represented in research and policy discussions is essential.
 
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.
 
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