Postpartum follow up of gestational diabetes in a Tertiary Care Center

Abstract

BackgroundGestational diabetes is a risk factor for future development of type 2 diabetes. The primary aim of this study was to estimate the prevalence of postpartum glucose tolerance status evaluation in pregnancies complicated by gestational diabetes 6–12 weeks after delivery. The secondary one was to identify the factors that are implicated with postpartum glucose retesting.MethodsThis was a retrospective study performed with a cohort of women with gestational diabetes, with prenatal care and delivery at a tertiary care center, from January 2013 to April 2017. The diagnosis of gestational diabetes was based on IADPSG criteria (Fasting ≥ 92 mg/dl, 1 h ≥ 180 mg/dl and/or 2 h ≥ 153 mg/dl, respectively) and the diagnosis of type 2 diabetes and prediabetes were made using the 2016 ADA’s criteria (fasting and 2 h after glucose load ≥ 126 mg/dl and/or ≥ 200 and 100–125 mg/dl and/or 140 and 199 mg/dl, respectively). All women had an appointment scheduled 6–12 weeks postpartum with the results of a 75-g oral glucose tolerance test (OGTT).ResultsOf the 152 evaluated women, 21 (13.8%) returned with the postpartum OGTT results. Of these, 9 (45.0%) had a diagnosis of prediabetes. The use of insulin during gestation was the only factor implicated in a higher adherence rate to postpartum testing OR 6.33 (p 0.002). No significance was found for other demographic and clinical variables (age, family income, years of study, parity, gestational age at first visit, smoking, family history of type 2 diabetes, diagnosis of gestational diabetes before the third trimester, pregestational body mass index, previous history of gestational diabetes and ethnicity).ConclusionThe majority of patients with gestational diabetes did not return postpartum to perform OGTT and in our study the only factor implicated in a higher postpartum return was the use of insulin during pregnancy. Considering that 45.0% were diagnosed with prediabetes, diabetes care teams should initially identify non-adherent patients.

An analysis of demographic and pregnancy outcome data to explain non-attendance for postpartum glucose testing in women with gestational diabetes mellitus

“…Another smaller study 11 found that the majority of patients did not attend for postpartum GTT and the only factor implicated in a higher rate of attendance was the use of antenatal insulin, as found in the BAME subgroup in our study.…”

<p>Predictors of Adherence to Self-Care Behavior Among Patients with Diabetes at Public Hospitals in West Ethiopia</p>

“…This similar finding proved that individuals' levels of their confidence toward diabetes management basic to reduce blood glucose. 38 …”

Continued Disparities in Postpartum Follow-Up and Screening Among Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy

“…These high rates may reflect, in part, the more ubiquitous nature of blood pressure screening as a standard vital sign as compared to glucose screening. Worldwide, postpartum diabetes screening rates are <50%, 33,34,36,37 either due to healthcare delivery system issues and timing of the test 38,39 or provider knowledge deficits related to standard of care recommendations. 35,39,40 Moreover, women who had GDM identify barriers to postpartum screening to include fatigue, 39 fear of a diabetes diagnosis, 41 incomplete understanding of the risk for diabetes, 42,43 more concern about delivery outcomes than long-term diabetes risk, and environmental issues such as transportation difficulties and work responsibilities.…”