Risk Factors for Poor Compliance With Postpartum Oral Glucose Tolerance Testing in Women With Gestational Diabetes Mellitus

Abstract

INTRODUCTION: Women with gestational diabetes mellitus (GDM) are at increased risk to develop overt diabetes; however, compliance with the postpartum 75-g oral glucose tolerance test (OGTT) is poor. We assessed rates of postpartum OGTT compliance at our institution and identified risk factors for the suspected poor compliance. METHODS: We performed a retrospective cohort study of singleton pregnancies with GDM who delivered at Columbia University Medical Center in 2011. Women were identified from institutional databases; data were abstracted from electronic medical records. Women with postpartum OGTT testing were compared with women without, and characteristics of these two groups—insurance status, parity, race, body mass index, and a history of prior GDM—were compared using χ2, Fisher's exact test, and Student's t test where appropriate. We also examined causes for noncompliance. RESULTS: Of the 6,272 women identified, 235 patients had GDM (4%). Of those, 21% had a postpartum OGTT (n=50). When compliant and noncompliant patients were compared, no significant differences existed in insurance status, age, race, parity, body mass index, or history of GDM. Privately insured patients were more likely to attend their postpartum visit than publicly insured patients (94% compared with 82%, P=.01). Patients who attended their postpartum visit were ordered for (63% compared with 53%, P=.19) and obtained postpartum OGTT (29% compared with 22%, P=.31) at similar rates. CONCLUSIONS: Compliance rates for postpartum diabetes testing are low. Regardless of compliance, the majority of women attended their postpartum visit; however, they were either not ordered a postpartum OGTT or failed to obtain it. These data are useful to develop a program targeting methods to increase compliance.