The importance of postpartum glucose tolerance testing after pregnancies complicated by gestational diabetes

McClean, S.; Farrar, Diane; Kelly, Catherine A.; Tuffnell, Derek; Whitelaw, Donald

doi:10.1111/j.1464-5491.2010.03001.x

Cited by 39 publications

(28 citation statements)

References 18 publications

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“…These results are similar to recent data from McClean et al (6), who found that an FPG cut off value of R6.1 mmol/l identified abnormal glucose tolerance in 199 of the 272 cases (sensitivity 0.73). Interestingly, of these 272 women, 109 had frank diabetes, of whom 11 (10%) had an FPG %6.0 mmol/l.…”

Section: Discussionsupporting

confidence: 82%

“…Reported prevalence of pre-diabetes and T2DM following GDM ranges from 7 to 35% (4). The current literature suggests that the rate of uptake of post partum diabetes screening is low, and that a fasting plasma glucose (FPG) alone may miss up to 72% of cases of post partum dysglycemia (5,6). To date studies on persistent post partum hyperglycemia have shown inconsistent results.…”

Section: Introductionmentioning

confidence: 99%

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Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

O’Reilly

Avalos

Dennedy

et al. 2011

European Journal of Endocrinology

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Objective: Gestational diabetes (GDM) is associated with adverse fetal and maternal outcomes, and identifies women at risk of future type 2 diabetes mellitus (T2DM). Breast-feeding may improve post partum maternal glucose tolerance. Our objective was to identify the prevalence of post partum dysglycemia after GDM, to delineate associated factors and to examine the effect of lactation on post partum glucose tolerance. Design: We compared post partum 75 g oral glucose tolerance test (OGTT) results from 300 women with GDM and 220 controls with normal gestational glucose tolerance (NGT) in five regional centers. Breast-feeding data was collected at time of OGTT. Methods: Post partum OGTT results were classified as normal (fasting plasma glucose (FPG) !5.6 mmol/l, 2 h !7.8 mmol/l) and abnormal (impaired fasting glucose (IFG), FPG 5.6-6.9 mmol/l; impaired glucose tolerance (IGT), 2 h glucose 7.8-11 mmol/l; IFGCIGT; T2DM, FPG R7 mmol/lG2 h glucose R11.1 mmol/l). Binary logistic regression was used to identify factors predictive of persistent hyperglycemia. Results: Five hundred and twenty women were tested; six (2.7%) with NGT in pregnancy had post partum dysglycemia compared with 57 (19%) with GDM in index pregnancy (P!0.001). NonEuropean ethnicity (odds ratio (OR) 3.40; 95% confidence interval (CI) 1.45-8.02, PZ0.005), family history of T2DM (OR 2.14; 95% CI 1.06-4.32, PZ0.034), and gestational insulin use (OR 2.62; 95% CI 1.17-5.87, PZ0.019) were associated with persistent dysglycemia. The prevalence of persistent hyperglycemia was significantly lower in women who breast-fed vs bottle-fed post partum (8.2 vs 18.4%, P!0.001). Conclusions: Non-European ethnicity, gestational insulin use, family history of T2DM, and elevated body mass index were associated with persistent dysglycemia after GDM. Breast-feeding may confer beneficial metabolic effects after GDM and should be encouraged. European Journal of Endocrinology 165 953-959

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

O’Reilly

Avalos

Dennedy

et al. 2011

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…When compared to the OGTT, single glucose and haemoglobin A1c levels have consistently been shown to be insensitive screening tests for type 2 diabetes in the postpartum period. [25][26][27][28][29][30][31][32][33] Recently, Capula et al found that 32.3% of women with previous GDM completed an OGTT within 6 and 12 weeks postpartum. Prepartum counselling and a diagnosis of polycystic ovarian syndrome were the strongest predictors of adherence to completing a postpartum OGTT.…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes

et al. 2014

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Background: Postpartum screening for diabetes in women with gestational diabetes (GDM) improves with use of reminder systems. Our primary objective was to identify predictors of diabetes screening in the first year after delivery. Methods: A retrospective study was performed of 556 women with GDM who received outpatient prenatal care between 2007 and 2009. A mailed reminder system was utilized at two sites. Rates of postpartum glucose testing at 6 and 12 months postpartum were measured. Results: Site of care and non-smoking status were identified as the only predictors of postpartum diabetes screening (p50.001 and p ¼ 0.02, respectively). Rates of OGTT completion at one year (38% vs. 19% p50.001) were higher in women who attended clinics with postpartum reminders. Conclusions: The site of diabetes care in pregnancy is a major predictor of adherence to diabetes screening postpartum. Health care delivery should be considered in the development of strategies to increase screening rates.

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“…However, this study does not report the sensitivity and specificity of fasting plasma glucose in identifying impaired glucose tolerance. Mc Lean et al showed that 18 a postpartum fasting plasma glucose measurement alone is not sensitive enough to classify glucose tolerance status accurately. Our survey showed 82% of units offered OGTT at six weeks postnatal period.…”

Section: Discussionmentioning

confidence: 99%

Screening, diagnosis and management of gestational diabetes mellitus: A national survey

et al. 2014

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Background and methods: We conducted a National survey between February and June 2012 to evaluate the practices concerning screening, diagnosis and management of Gestational Diabetes (GDM) in England.Results: A total of 102/126 (80%) maternity units responded. The National Institute of Health and Clinical Excellence (NICE) recommended screening criteria were used by 83% of units. All the units performed 2 h 75 g oral glucose tolerance test (OGTT) between 24 and 28 weeks. There was a wide variation in the diagnostic blood glucose values used by different units. About 86% of units used a 2 h blood glucose value of 7.8 mmol/l and 45% of units used fasting value 6.1 mmol/l to diagnose GDM. Only 26% of units advised self-monitoring of blood glucose pre meal and 1 h post-meal, whereas 64% of units advised monitoring 2 h after the meal. Metformin was started when women did not respond to dietary measures in 101 units (99%). Regular growth scans every four weeks from 28 weeks onwards were performed by 99 units (97%). Women on metformin with no complications were offered induction of labour at 38 completed weeks in 97 units (95%). 84 maternity units (82.3%) offered OGTT six weeks postnatally. Conclusion:Our survey has shown consistency in screening using the NICE criteria, use of 2 h 75 g OGTT at 24-28 weeks, in providing dietary support, use of metformin and ultrasound for fetal growth. But there is wide variation in the criteria used to diagnose GDM, self-monitoring of blood glucose, induction of labour and six weeks postnatal testing.

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The importance of postpartum glucose tolerance testing after pregnancies complicated by gestational diabetes

Cited by 39 publications

References 18 publications

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

Atlantic DIP: high prevalence of abnormal glucose tolerance post partum is reduced by breast-feeding in women with prior gestational diabetes mellitus

Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes

Screening, diagnosis and management of gestational diabetes mellitus: A national survey

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