Early postpartum glycaemic assessment in patients with gestational diabetes

Abstract

Uptake of postpartum glycaemic assessment in women with gestational diabetes (GDM) has been shown to be low, with six weeks postpartum testing (as recommended by the UK National Institute for Health and Care Excellence) inconvenient for new mothers who prioritise their new baby over their own health at this time. As pregnancy‐related insulin resistance returns to pre‐pregnancy levels immediately after placental delivery, we hypothesised that early postpartum fasting blood glucose testing, while the mother is likely to be still in hospital, would increase uptake of postpartum glycaemic assessment. A novel protocol for early postpartum fasting blood glucose testing in women with GDM was implemented and prospectively evaluated looking at uptake of postpartum glycaemic testing in the first year after implementation. In all, 118 consecutive patients with GDM delivered in our trust between September 2015 and September 2016. Mean (SD) age was 32(5.7) years; mean (SD) body mass index was 30.6(6.5)kg/m2. A total of 107 patients (90.7%) had a fasting glucose test while in hospital, five re‐attended the maternity unit for a fasting glucose within four weeks, giving a total uptake of postpartum glycaemic testing of 94.9%. Two (1.8%) patients had impaired fasting glucose and no patients had a fasting glucose of 7mmol/L or greater detected by early postpartum testing. It was concluded that early postpartum glycaemic assessment in women with GDM, using fasting blood glucose measurement while still in hospital after delivery, is an effective strategy that improves the follow‐up rate to near complete uptake. Copyright © 2017 John Wiley & Sons.

Utility of in-hospital post-delivery fasting plasma glucose to predict postpartum glucose status in women with hyperglycaemia first detected in pregnancy: A prospective cohort study

“…The results of this study showed a significant, temporary improvement in maternal fasting glucose in all subcategories of glycaemia 24–72 hours following delivery. In contrast to similar published work, early post-delivery glucose testing was not found to be a feasible alternative to the standard of care 4-12-week postpartum visit in women with HFDP within our population group [ 14 , 17 – 21 ]. The study failed to identify high risk individuals and did not demonstrate that in-hospital fasting glucose could help to direct resources to those most in need of surveillance.…”

“…Published studies pertaining to early post-delivery glucose assessment in GDM women as an alternative to the 4-12 week OGTT were mostly favourable. Curtis et al, (2017) explored this novel approach in 118 GDM women in the UK [14] . Similar to the findings of our study 110/115 women (95.6%) had a normal FPG at t1.…”

“…The postpartum glucose evaluation compliments antenatal glucose control, allows for timeous interventions to delay T2DM or provides an opportunity for early diagnosis and prevention of complications of pre-existing T2DM [ 9 , 10 , 13 ] . The timing of the 4–12 week postpartum OGTT appears to have been chosen for convenience [ 14 ], but poor attendance rates globally argue against the convenience of this visit for mothers who prioritize the care of their new-born including immunisation at this time, a problem reflected locally [ 15 ] . Primary health care facilities in South Africa tasked with immunization of babies at 6 weeks only offer postpartum glucose testing in the context of a clinical research setting.…”

Gestational diabetes: screening uptake, current challenges and the future – a focused review

“…29 Finally, Curtis et al showed that early post-partum glycaemic assessment with a FPG performed before hospital discharge was associated with a total uptake of 94.9%, and is therefore an effective strategy to increase screening uptake in women with previous GDM. 30 While this is a relatively new strategy for post-partum glucose screening, the authors suggested that these results would not be much different to those of the 6-week post-partum testing recommended by NICE. 30 The subsequent follow-up of women with previous GDM should still remain a priority, while the validity of this strategy needs to be further evaluated by studies on larger populations.…”

“…30 While this is a relatively new strategy for post-partum glucose screening, the authors suggested that these results would not be much different to those of the 6-week post-partum testing recommended by NICE. 30 The subsequent follow-up of women with previous GDM should still remain a priority, while the validity of this strategy needs to be further evaluated by studies on larger populations. 30 Women with a history of GDM are high-risk individuals who require a consistent, patient-centred approach and management.…”