Incidence of Abnormal Glucose Values Following Delivery in Women With Gestational Diabetes [18D

Abstract

INTRODUCTION: Limited evidence guides the immediate postpartum (PP) management of gestational diabetes (GDM). Protocols vary from universal, selective, or not screening glucose levels after delivery. We assessed the incidence of PP hyperglycemia, treatment, and risk factors for diabetes medications at discharge. METHODS: An IRB-approved retrospective cohort study of all women with GDM delivering at a large academic medical center that employs universal PP screening between Jan 2015-Nov 2017 was conducted to assess PP blood glucose (BG) levels and treatment. RESULTS: 1039 women were included (GDMA1 n=509, GDMA2 n=503, GDMA2 vs T2DM n=27). Only 14% of women had 1 or more episodes of PP hyperglycemia (BG greater than 180 mg/dl). PP hyperglycemia increased with intensity of antepartum glucose management (1 or more elevated values: 11% diet, 17% oral medications, 22% insulin; p 0.01). Total daily insulin dose at admission was associated with increasing PP hyperglycemia (P=.015). Hyperglycemia was associated with non-white race (OR 1.53, 95% CI 1.0–2.3) and diabetes severity (GDMA2 OR 1.59, 95% CI 1.1–2.3; GDMA2 vs T2DM OR 11.14, 95% CI 4.8–25.9) and inversely associated with Cesarean delivery (OR 0.44, 95% CI 0.3–0.7) 20 women (1-GDMA1, 13 -GDMA2, 6-GDMA2 vs T2DM) were discharged on hypoglycemic medications. CONCLUSION: Only 1 in 7 women with GDM had immediate PP hyperglycemia. Universal PP screening resulted in evaluating over 1000 women to identify very few who were ultimately discharged on medications. GDM type and total insulin dose are strong predictors of those at risk. These findings should inform in-hospital screening protocols for postpartum GDM management.