Postpartum diabetes screening in women with a history of gestational diabetes

  • Smirnakis K
  • Chasan-Taber L
  • Wolf M
 et al. 
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Abstract

OBJECTIVE: Women with a history of gestational diabetes mellitus (GDM) are at high risk for developing type 2 diabetes (diabetes mellitus, DM). The American Diabetes Association recommends regular postpartum diabetes screening for women with a history of GDM, but the American College of Obstetricians and Gynecologists (ACOG) is not as directive. We sought to examine postpartum glycemic testing in women diagnosed with GDM. METHODS: We conducted an observational cohort study of women diagnosed with GDM at one of two large academic medical centers between 2000 and 2001. Kaplan-Meier estimates of the time from delivery to the first postpartum DM screening tests were determined, and predictors of postpartum DM screening were examined using Cox proportional hazards testing. RESULTS: Only 37% of eligible women underwent the postpartum diabetes screening tests recommended by the American Diabetes Association (fasting glucose or oral glucose tolerance test [OGTT]), with a median time from delivery to the first such testing of 428 days. By comparison, 94% of women underwent postpartum cervical cancer screening using a Papanicolaou (Pap) test, with a median time from delivery to Pap testing of 49 days. Even when random glucose testing was included in a broad definition of postpartum DM screening (random or fasting glucose, glycosylated hemoglobin, or OGTT), only two thirds of women (67%) received a postpartum glycemic assessment. CONCLUSION: In the population studied, only 37% of women with a history of GDM were screened for postpartum DM according to guidelines published by the American Diabetes Association. Efforts to improve postpartum DM screening in this high-risk group are warranted.

Author-supplied keywords

  • Adult
  • Age Factors
  • Blood Glucose/analysis
  • Cohort Studies
  • Confidence Intervals
  • Diabetes Mellitus, Type 2/*diagnosis/*epidemiology
  • Diabetes, Gestational/*diagnosis/*epidemiology
  • Female
  • Follow-Up Studies
  • Glucose Tolerance Test
  • Humans
  • Incidence
  • Mass Screening/*methods
  • Maternal Age
  • Multivariate Analysis
  • Postpartum Period
  • Pregnancy
  • Probability
  • Proportional Hazards Models
  • Risk Assessment

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Authors

  • K V Smirnakis

  • L Chasan-Taber

  • M Wolf

  • G Markenson

  • J L Ecker

  • R Thadhani

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