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

Abstract

Background Women with hyperglycaemia first detected in pregnancy (HFDP), including those with gestational diabetes mellitus (GDM), should undergo a glucose evaluation 4-12 weeks after delivery. Globally, suboptimal postpartum return rates limit the opportunity to intervene in women with sustained hyperglycaemia and pragmatic solutions should be sought to bridge this gap. Objective To assess the utility of postpartum in-hospital glucose evaluation to predict the outcome of the oral glucose tolerance test (OGTT) performed 4-12 weeks after delivery. Methods The study was performed prospectively at Tygerberg Hospital, Cape Town, South Africa. Women with HFDP, classified as GDM based on the modified National Institute for Health and Care Excellence criteria, who delivered between November 2018 and June 2019 were included in the study. Fasting plasma glucose (FPG) was performed 24-72 hours after delivery (t1) in the postnatal ward, provided glucose lowering medication was discontinued at delivery. An OGTT 4-12 weeks postpartum (t2) was scheduled for the total cohort. We compared glucose values and glucose categories at t1 and t2 and evaluated antenatal characteristics of women who returned, compared to the group that was lost to follow-up. Results In-hospital post-delivery glucose assessment (t1) was performed in 115 women. Glucose levels were significantly lower at t1 compared to antenatal diagnostic values (t0) and

Effects of Implementing a Routine Postpartum Fasting Blood Glucose on the Completion of the Gold Standard 2-Hour Oral Glucose Tolerance Test in Gestational Diabetics

“…Efforts to improve compliance with the 2-hour OGTT, including electronic reminder systems, education programs, and calling patients, have only led to modest increases in compliance and are labor intensive. [11][12][13] Investigators have also initiated screening tests while in the hospital, including an immediate FBG or 2-hour OGTT, [14][15][16][17] concluding this is a feasible option for screening. Our retrospective study evaluates a new prospective, however, that initiating these inpatient tests could affect compliance with the gold standard screening test.…”

“…[11][12][13] To increase compliance with screening, investigators have initiated screening tests while in the hospital, concluding that this is a feasible option which needs further investigation. [14][15][16][17] Currently, the Endocrine Society recommends obtaining fasting blood glucose (FBG) at 24 to 72 hours after delivery to rule out ongoing hyperglycemia, and initiating treatment if the fasting glucose suggests overt diabetes. 18 We lack evidence, however, on whether implementation of routine postpartum FBG impacts the likelihood of obtaining the gold standard OGTT.…”

Hyperglycemia First Detected in Pregnancy in South Africa: Facts, Gaps, and Opportunities

“…This will facilitate the optimal use of available diabetes prevention and early management resources. To overcome the problem of low postpartum follow-up rates after GDM and improve efficiency in the healthcare system, Wessels et al investigated in-hospital post-delivery glucose and its ability to replace the 4-12-week OGTT (179). In contrast to similar studies, early post-delivery glucose was not an alternative to OGTT testing 4-12 weeks after delivery.…”

Can We Predict the Insulin Therapy Need and Early Postpartum Prediabetes in Patients with Gestational Diabetes Mellitus?

“…Recent meta-analysis of 20 studies shows that women after GDM have nearly 10 times higher DM2 risk compared to healthy counterparts [6]. It should be noted that only a small fraction of patients will develop prediabetes and type 2 diabetes shortly after pregnancy [7,8] including those with gestational diabetes mellitus (GDM. However, the prediction of these events and the assessment of risk factors are of significant clinical importance in order to apply appropriate prevention (diet and exercise) and to establish an appropriate diagnosis of carbohydrate disorders as soon as possible.…”