Postpartum Glucose Follow-up Screening Among Women With Gestational Diabetes Mellitus: A Retrospective Cohort Study

Abstract

Abstract Objective To evaluate the impact of pre-gestational and gestational characteristics on postpartum glucose follow-up screening (PGFS) compliance in women diagnosed with gestational diabetes mellitus (GDM) in southwest China. Methods This retrospective cohort study was conducted in West China Second Hospital, Sichuan University. Pre-gestational and gestational factors were extracted from hospital records and compared between women who completed PGFS and those who did not. The screening method chosen was the 75g oral glucose tolerance test (OGTT), performed 4–12 weeks postpartum. Univariate analysis, logistic regression analysis, and Cochran-Armitage test were used to assess associations between maternal characteristics and PGFS compliance. Results A total of 3047 women with GDM were included, with a PGFS completion rate of 47.2%. Of those who completed PGFS, 430 women (29.9%) presented abnormal results: 1.8% with impaired fasting glucose (IFG), 24.1% with impaired glucose tolerance (IGT), 2.2% with both IFG and IGT 2.2%, and 1.8% with suspected diabetes. Independent factors associated with non-compliance to PGFS included higher pre-gestational BMI (odds ratio (OR): 0.952; 95% confidence interval (CI): 0.922, 0.984), multipara (OR: 0.721; 95% CI: 0.593, 0.877), use of assisted reproduction technology (ART) (OR: 1.427; 95% CI: 1.080, 1.885), excessive gestational weight gain (OR: 0.956; 95% CI: 0.936, 0.977), elevated fasting plasma glucose (FPG) prior to delivery (OR: 0.909; 95% CI: 0.835, 0.988), and undergoing cesarean section (OR: 1.232; 95% CI: 1.017, 1.492) were independent influencing factors of failing to PGFS. PGFS completion rates significantly decreased with increasing pre-gestational BMI and earlier gestational age (P < 0.001). Conclusions Establishing dedicated postpartum follow-up teams and targeting women with higher pre-gestational BMI, multiparity, ART use, excessive gestational weight gain, elevated pre-delivery FPG, and those undergoing cesarean section are critical to improving postpartum GDM management.