Diabetes Screening in US Women With a History of Gestational Diabetes, National Health and Nutrition Examination Survey, 2007-2012.

Bernice Man,Michelle A Kominiarek,Mary E Turyk,Ben S Gerber,Yinglin Xia

doi:10.5888/pcd13.160106

Abstract

IntroductionWomen with a history of gestational diabetes mellitus (GDM) are at increased risk for developing type 2 diabetes mellitus. We examined individual, socioeconomic, and health care use characteristics of women with a history of GDM and the association of those characteristics with diabetes screening, and we estimated their rates of undiagnosed prediabetes and diabetes.MethodsUsing 3 cycles of the National Health and Nutrition Examination Survey (2007–2008, 2009–2010, and 2011–2012), we identified 284 women with a history of GDM who were eligible for diabetes screening. Screening status was defined by self-report of having had a blood test for diabetes within the prior 3 years. Undiagnosed prediabetes and diabetes were assessed by hemoglobin A1c measurement.ResultsAmong women with a history of GDM, 67% reported diabetes screening within the prior 3 years. Weighted bivariate analyses showed screened women differed from unscreened women in measured body mass index (BMI) category (P = .01) and number of health visits in the prior year (P = .001). In multivariable analysis, screening was associated with a greater number of health visits in the prior year (1 visit vs 0 visits, adjusted odds ratio [AOR], 1.91; 95% confidence interval [CI], 0.71–5.18; 2 or 3 visits, AOR, 7.05; and ≥4 visits, AOR, 5.83). Overall, 24.4% (95% CI, 18.3%–31.7%) of women had undiagnosed prediabetes and 6.5% (95% CI, 3.7%–11.3%) had undiagnosed diabetes.ConclusionMore health visits in the prior year was associated with receiving diabetes screening. Fewer opportunities for screening may delay early detection, clinical management, and prevention of diabetes. Prediabetes in women with a history of GDM may be underrecognized and inadequately treated.

Highlights

Infants and Children (Women) with a history of gestational diabetes mellitus (GDM) are at increased risk for developing type 2 diabetes mellitus
More health visits in the prior year was associated with receiving diabetes screening
We examined the following variables: race/ethnicity, age, education level, family income-to-poverty ratio (FIPR), marital status, body mass index (BMI), foreign-born status, language preference, age at GDM diagnosis, health insurance status, type of health insurance, place used for routine health care, number of health care visits in prior year, number of pregnancies, number of live births, age at first and last birth, and having a baby with a birthweight of 9 pounds or greater

Summary

Introduction

Women with a history of gestational diabetes mellitus (GDM) are at increased risk for developing type 2 diabetes mellitus. The American Diabetes Association and American College of Obstetricians and Gynecologists recommend diabetes screening at 6 to 12 weeks postpartum with a 2-hour, 75-g OGTT [1,2]. Both organizations recommend lifelong screening for diabetes at least once every 3 years and annual screening for those with prediabetes [1,2]. 50% of women with a history of GDM obtain diabetes screening, with rates ranging from 30% to 70% [8]. Screening with the recommended OGTT is uncommon [9]; most studies recognize or consider any marker of glucose measure as a screen-

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Conclusion