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.