Prevalence and predictive factors of early postpartum diabetes among women with gestational diabetes in a single‐center cohort

Abstract

The high prevalence of diabetes supports early postpartum oral glucose tolerance testing. Several women had undiagnosed diabetes. The risk factors identified could be useful for prenatal risk stratification.

A comparison between point‐of‐care testing and venous glucose determination for the diagnosis of diabetes mellitus 6–12 weeks after gestational diabetes

“…In previous South African studies, a FPG has been shown very effective in detecting GDM; and identifying Type 2 diabetes early post-partum [11,28]. Good clinical accuracy was documented for POCT in the fasting state in the index study and fasting measurements were also close to the rigorous laboratory requirements for analytical accuracy.…”

“…Physiological adaptations, implicated in the biochemical inaccuracy during gestation, are expected to revert soon after delivery [30]. Additionally, the postpartum population in this study has a high prevalence of Type 2 diabetes [11]. It is known that POCT devices do not perform consistently across glucose ranges [31].…”

“…The current evaluation was nested within a larger ongoing study designed to determine the prevalence and predictive factors of diabetes after delivery in women diagnosed with GDM in the index pregnancy [11]. The initial screening for Type 2 diabetes post-partum can be performed on POCT in remote settings where laboratory glucose is not readily accessible.…”

“…This study was a prospective comparison of two methodologies for glucose determination, formal laboratory glucose and finger-prick POCT, that was nested within a study investigating the prevalence and predictive factors of Type 2 diabetes 6-12 weeks postpartum in women with GDM [11]. GDM was confirmed antenatal if the fasting glucose was ≥ 5.6 mmol/l and/or the 2-h glucose value after a glucose load was ≥ 7.8 mmol/l [10].…”

“…Unlike the International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria, Western Cape Provincial Guidelines for the management of diabetes in pregnancy in South Africa do not distinguish between GDM and overt Type 2 diabetes based on the degree of glucose elevation [9,10]. The spectrum of newly diagnosed glucose abnormalities detected during pregnancy at Tygerberg Hospital therefore includes both Type 2 diabetes and GDM [11]. This lack of a distinction could result in all Type 2 diabetes first identified antenatally, being erroneously classified as GDM with the incorrect assumption that the glucose abnormality will resolve after delivery.…”