Barriers to completing oral glucose tolerance testing in women at risk of gestational diabetes.

E H Lachmann,R A Dennison,C L Meek,J A Usher‐Smith,C E Aiken,R A Fox

doi:10.1111/dme.14292

Abstract

AimComplications of gestational diabetes (GDM) can be mitigated if the diagnosis is recognized. However, some at‐risk women do not complete antenatal diagnostic oral glucose tolerance testing (OGTT). We aimed to understand reasons contributing to non‐completion, particularly to identify modifiable factors.MethodsSome 1906 women attending a tertiary UK obstetrics centre (2018–2019) were invited for OGTT based on risk‐factor assessment. Demographic information, test results and reasons for non‐completion were collected from the medical record. Logistic regression was used to analyse factors associated with non‐completion.ResultsSome 242 women (12.3%) did not complete at least one OGTT, of whom 32.2% (n = 78) never completed testing. In adjusted analysis, any non‐completion was associated with younger maternal age [≤ 30 years; odds ratio (OR) 2.3, 95% confidence interval (CI) 1.6–3.4; P < 0.001], Black African ethnicity (OR 2.7, 95% CI 1.2–5.5; P = 0.011), lower socio‐economic status (OR 0.9, 95% CI 0.8–1.0; P = 0.021) and higher parity (≥ 2; OR 1.8, 95% CI 1.1–2.8; P = 0.013). Non‐completion was more likely if testing indications included BMI ≥ 30 kg/m2 (OR 1.7, 95% CI 1.1–2.4; P = 0.009) or family history of diabetes (OR 2.2, 95% CI 1.5–3.3; P < 0.001) and less likely if the indication was an ultrasound finding (OR 0.4, 95% CI 0.2–0.9; P = 0.035). We identified a common overlapping cluster of reasons for non‐completion, including inability to tolerate test protocol (21%), social/mental health issues (22%), and difficulty keeping track of multiple antenatal appointments (15%).ConclusionsThere is a need to investigate methods of testing that are easier for high‐risk groups to schedule and tolerate, with fuller explanation of test indications and additional support for vulnerable groups.

Highlights

Gestational diabetes (GDM) is increasing in prevalence in many maternity populations globally, with current estimates ranging from < 1% to 28% [1]
Any non-completion was associated with younger maternal age [≤ 30 years; odds ratio (OR) 2.3, 95% confidence interval (CI) 1.6–3.4; P < 0.001], Black African ethnicity, lower socio-economic status and higher parity (≥ 2; OR 1.8, 95% CI 1.1–2.8; P = 0.013)
Non-completion was more likely if testing indications included BMI ≥ 30 kg/m2 or family history of diabetes and less likely if the indication was an ultrasound finding

Summary

Introduction

Gestational diabetes (GDM) is increasing in prevalence in many maternity populations globally, with current estimates ranging from < 1% to 28% [1]. GDM diagnosis relies on women attending and completing a relatively complicated standardized testing protocol. The gold standard test for GDM diagnosis in most contexts is the oral glucose tolerance test (OGTT) [8]. Completing an OGTT relies on pregnant women attending a morning appointment in a fasting state, drinking a fixed load of glucose, spending at least two hours in the testing facility, and undergoing multiple blood draws. In the UK, and several other European countries, such testing is offered only to women deemed at high-risk of GDM [10,11] due to the expense and inconvenience of the a 2020 The Authors

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