Postpartum Glucose Tolerance Research Articles

Administration of the Postpartum Glucose Tolerance Test During the Delivery Hospitalization Compared With 4–12 Weeks Postpartum

Administration of the Postpartum Glucose Tolerance Test During the Delivery Hospitalization Compared With 4–12 Weeks Postpartum

1236-P: Gestational Diabetes Mellitus in Georgia, United States—Factors Associated with Postpartum Glucose Tolerance Testing Completion

1236-P: Gestational Diabetes Mellitus in Georgia, United States—Factors Associated with Postpartum Glucose Tolerance Testing Completion

Efficacy of a phone reminder to improve adherence to post-partum glucose tolerance testing after gestational diabetes and clinical predictors of post-partum follow-up compliance

AimTo assess the effectiveness of a phone reminder to improve adherence to post-partum glucose tolerance testing in women with gestational diabetes mellitus (GDM) and to identify clinical predictors of adherence to post-partum follow-up. MethodsRetrospective study including 543 women with GDM. We assessed the adherence rate to post-partum glucose tolerance testing in women who received a phone reminder (n = 297) compared to women not alerted (n = 246). Demographic and clinical variables were collected to identify the predictors of adherence to the post-partum oral glucose tolerance test (OGTT). ResultsThe adherence to post-partum OGTT was higher in women who received the phone reminder compared to those not alerted (60.6 % vs. 35.4 %, p < 0.001). Women less compliant compared to those more compliant, had a higher pre-pregnancy body mass index (BMI) (29.3 ± 7.9 vs. 27.0 ± 6.1 Kg/m2, p = 0.03). The adherence was lower in pre-pregnant obese compared to non-obese women (42.7 % vs. 52.0 %, p < 0.05), in women with only one, compared to multiple OGTT alterations during pregnancy (44.5 % vs. 57.8 %, p < 0.05), and in women non-insulin treated compared to those insulin-treated (40.0 % vs. 57.1 % vs, p < 0.001). ConclusionsThe phone reminder improved post-partum follow-up adherence. Pre-pregnancy BMI, number of OGTT alterations and type of therapy could identify poorly adherent women.

Determination of the Contributing Factors and HbA1c Cutoff Leading to Glucose Tolerance Abnormalities Following Gestational Diabetes.

The prevalence of gestational diabetes mellitus (GDM) has been steadily increasing over the past years. It is a major risk factor for glucose intolerance and type 2 DM (T2DM). The American Diabetes Association recommends that women whose pregnancy was complicated by GDM be screened for persistent glucose abnormalities at six to 12 weeks postpartum with either a fasting plasma glucose test alone or with a fasting 75-g, two-hour oral glucose tolerance test. This study aimed to identify the main predictive factors of glucose tolerance disorders in early postpartum women with a recent history of GDM. In this retrospective descriptive study, we identified 400 women who met the eligibility criteria for the study. The mean age was 34.54 ± 5.51 years. A total of 70% had a family history of DM, 16% had a personal history of GDM, and 23% had fetal macrosomia in previous pregnancies. The overall incidence of postpartum carbohydrate tolerance disorders was 36.4%, including 12% prediabetes and 24.4% DM. The prevalence of prediabetes and T2DM after delivery was higher with older maternal age, multigravidity, a higher BMI, a history of GDM, and fetal macrosomia in previous pregnancies. Furthermore, the persistence of this impaired glucose tolerance in postpartum was associated with a higher term of diagnosis, a higher glycated hemoglobin (HbA1c) percentage (the discriminant cutoff value with the best sensitivity/specificity ratio was 5.25%), the use of insulin therapy, cesarean section delivery, and fetal macrosomia. After adjusting for confounders, only prior GDM, a higher HbA1c level, macrosomia, and gestational term were found to significantly affect postpartum glucose tolerance. Although postpartum screening for T2DM is recommended for all women with GDM, a significant number of patients fail it. A better knowledge of predictive factors for this outcome is therefore needed for a more effective and targeted medical intervention.

Implementation of In-Hospital Postpartum Glucose Tolerance Testing for People with Gestational Diabetes.

We aimed to evaluate uptake of the glucose tolerance test performed during delivery hospitalization as part of routine clinical care. This is a retrospective cohort study of people with GDM at a tertiary center. We collected 9 months of postimplementation data after the in-hospital ("early") glucose tolerance test was adopted as a routine screening option. Adherence was compared between those who elected early glucose tolerance testing versus those who deferred testing to the standard postpartum period. Bivariable statistics including demographics, care team, and postpartum testing/visit attendance were compared between those who received early testing and those who did not using chi-square, Fisher's exact, and t-tests. A total of 681 patients with GDM delivered during the study period. Of those who had an early glucose tolerance test ordered (n = 408), 340 (83.3%) completed the test. Among those who did not complete an early glucose tolerance test (ordered and not completed or never ordered), only 104/341 (30.5%) completed any postpartum glucose testing in the first 12 months of postpartum. There were significant differences in characteristics in terms of race/ethnicity, insurance, type of gestational diabetes (A1GDM vs. A2GDM), diabetes medications, obstetric care provider, and delivery mode. Among those who completed early testing, 43.7% of participants had impaired glucose metabolism and 6.5% had values concerning for overt diabetes mellitus. Among those who deferred testing to the standard 6- to 12-week period, 24.0% had impaired glucose metabolism and none had overt diabetes. Those who completed an early glucose tolerance test had a lower rate of postpartum visit attendance compared with those who deferred (75.6 vs. 91.5%, p < 0.01). In this cohort, when the early glucose tolerance test is offered in clinical practice, adherence rates are higher than when the test is deferred until the postpartum visit. · Adherence rates with the early glucose tolerance test (GTT) are higher than if the testing is deferred.. · Those who completed an early GTT had a lower rate of postpartum visit attendance compared with those who deferred.. · Offering an in-hospital postpartum GTT can help address low rates of glucose testing postpartum..

A-316 Suboptimal Compliance to Postpartum Glucose Monitoring in a High-risk Pregnancy Population - A Single Center Study

Abstract Background Gestational diabetes mellitus (GDM) is a predictive factor in developing type 2 diabetes mellitus (T2DM) in affected mothers and their offspring. Its prevalence is increasing proportionally with the obesity epidemic, affecting 10% of pregnant women and 50% of which are likely to develop T2DM. Current guidelines by the American Diabetes Association and the American College of Obstetricians and Gynecologists recommend screening at 4–12 weeks with a 2-hour postpartum glucose tolerance test (OGTT) in patients with a history of GDM. However, several studies have reported suboptimal test ordering and completion rates attributable to the busy postpartum period and provider role confusion between primary care physicians and obstetricians. Due to the complex maternal-fetal cases encountered at our institution, the aim of this study is to evaluate the ordering and test completion rates amongst care providers and patients to ensure compliance with stipulated guidelines. Method We conducted a retrospective audit of women diagnosed with GDM who delivered at our institution from Jan 2019–Oct 2022. We abstracted data from electronic health records. Gestational diabetes was defined by one or more of the following: abnormal 3hr OGTT or 1-hour OGTT of &amp;gt;/=200 mg/dL at &amp;gt;/= 24 weeks. We excluded patients with pre-existing diabetes defined by diagnosis code or by an abnormal 1st trimester 3hr GTT or HbA1C and patients who did not return for a postpartum visit. We compared the proportions of patients with postpartum glucose monitoring orders (glucose tolerance tests or Hemoglobin A1C) to those without orders. Factors such as race, GDM management, provider type and insurance carrier were assessed as potential barriers to non-compliance. Results We identified 356 patients who were diagnosed with GDM during the study period. Of these, 158 patients were excluded who had pre-existing diabetes or did not return for postpartum care. The mean (SD) maternal age was 33.2 (6.0) years. Seventy-four percent (147/198) of patients had a postpartum glucose tolerance test order (Group A), and 26% (51/198) had no laboratory order for glucose monitoring (Group B). The proportion of patients with a completed test order was 24% (35/147), of which four results were abnormal (indicated for diabetes or pre-diabetes). There was no difference in parity, ethnicity, insurance type, diabetes management and provider type between the two groups. Poor compliance was observed in patients with glucose tolerance laboratory orders, while patients with an HbA1c order were 100% compliant. Conclusion Overall, this report demonstrates poor patient compliance with postpartum glucose tolerance testing. Although HbA1C is not recommended for postpartum glucose monitoring, patients were more likely to complete this test.

1191-P: GDM in Twin Pregnancies—Maternal Characteristics and Pregnancy Outcomes

The incidence of both gestational diabetes mellitus (GDM) and twin pregnancies have increased over the past two decades. While the same GDM diagnostic criteria and treatment targets are used for singleton and twin pregnancies, data on outcomes for twin pregnancies with GDM are limited. The aim of this retrospective cohort study is to present comprehensive data on maternal characteristics and pregnancy outcomes for individuals with a twin pregnancy who were diagnosed with GDM and attended our center for prenatal care from 2002-22. In total 185 individuals were identified with a mean age of 32 (± 5) years and a mean prepregnancy body mass index of 31.3 (± 7) kg/m2. The majority were dichorionic diamniotic (n=146, 79%), 32 (17%) had a prior diagnosis of GDM and 63 (34%) had prepregnancy fertility treatment. Women underwent universal screening with a 50g glucose challenge test (normal &amp;lt;140mg/dL) and Carpenter and Coustan Criteria were used to diagnose GDM. Pharmacological therapy was required to treat GDM in 68 (37%) cases. Hypertensive disorders of pregnancy were common (n=55, 30%), as was Cesarean delivery (n= 133, 72%). Assessment of pregnancy outcomes (n=370) revealed 360 (97%) livebirths, 8 (2%) stillbirths and 2 (0.6%) neonatal deaths. Among livebirths and neonatal deaths, premature delivery &amp;lt; 37 weeks was recorded in 225 (62.2%) and &amp;lt;34 weeks in 57 (15.7%). Neonatal macrosomia (birthweight &amp;gt;4.0kg) was rare (n=4, 1%), but low birthweight (&amp;lt;2.5kg) occurred in 168 (46%). Neonatal hypoglycemia was documented in 89 (25%) infants. Maternal attendance at the postpartum glucose tolerance test was low (n=47, 25.5%) individuals, and 38 had a subsequent pregnancy with GDM diagnosed in 18 (47%). In summary, the standard GDM diagnostic criteria applied to twin pregnancies identify a maternal cohort at high risk of pregnancy complications and future GDM. Future work should address the optimal nutritional and glycemic goals for this population, particularly considering the high risk of low birthweight and premature neonates. Disclosure D.M.Das: None. A.Vella: Advisory Panel; Rezolute, Inc., Consultant; Crinetics Pharmaceuticals, Inc., Hanmi Pharm. Co., Ltd., Zealand Pharma A/S, Other Relationship; Novo Nordisk. A.M.Egan: None. Funding National Institutes of Health (DK092721, HD065987)

The Glucose Challenge Test in Pregnancy Identifies Future Risk of Diabetes.

Women with gestational diabetes (GDM) have an increased future risk of type 2 diabetes but, in practice, their recommended postpartum glucose tolerance testing is often missed or substituted with measurement of A1c instead. We hypothesized that the antenatal screening glucose challenge test (GCT) should predict future diabetes risk and, if so, would have thresholds that identify the same degree of risk as the diagnosis of prediabetes on postpartum measurement of A1c. With population-based administrative databases, we identified all women in Ontario, Canada, who had a GCT in pregnancy with delivery between January 2007 and December 2017, followed by measurement of A1c and fasting glucose within 2 years postpartum (n = 141 858, including 19 034 with GDM). Women were followed over a median of 3.5 years for the development of diabetes. Under the assumption of a linear exposure effect, the 1-hour post-challenge glucose concentration on the GCT was associated with an increased likelihood of developing diabetes (hazard ratio 1.39; 95% CI, 1.38-1.40). A GCT threshold of 8.0 mmol/L predicted the same 5-year risk of diabetes (6.0%; 95% CI, 5.8-6.2) as postpartum A1c 5.7% (identifying prediabetes). Moreover, in women with GDM, a GCT threshold of 9.8 mmol/L equaled prediabetes on postpartum A1c in predicting a 5-year risk of diabetes of 16.5% (14.8-18.2). The GCT offers predictive capacity for future diabetes in pregnant women. In women with GDM, this insight could identify those at highest risk of diabetes, toward whom postpartum screening efforts should be most strongly directed.

Implementation of In-Hospital Postpartum Glucose Tolerance Testing for People With Gestational Diabetes [ID: 1375592

INTRODUCTION: The 2-hour glucose tolerance test (GTT) performed during delivery hospitalization is as predictive of postpartum dysglycemia as the 4- to 12-week test. Our objective was to assess test uptake as part of routine care rather than a research protocol. METHODS: This is a retrospective cohort study of patients with gestational diabetes mellitus (GDM) at a high volume center. The in-hospital (“early”) GTT began being offered in early 2021 as postpartum glucose screening option, and we collected 6 months of postimplementation data. Adherence to the GTT was compared between those who elected an early GTT versus those who deferred testing. Descriptive characteristics including demographics, care team characteristics, and postpartum testing/visit attendance were compared between those who received an early GTT and those who did not. Institutional review board approval was waived. RESULTS: Six hundred eighty-one patients with GDM delivered during the study period, and 340 (50%) received the early GTT. Of those who had an early GTT ordered (n=408), 83.3% completed the test. Among those who did not receive an early GTT, only 104 (30.5%) completed any postpartum glucose testing. There were significant differences in demographic characteristics among those who completed the early GTT compared to those who did not. When postpartum visit attendance was assessed, those who completed an early GTT had a lower rate of attendance compared to those who deferred (75.6% versus 91.5%, P&lt;.01). CONCLUSION: When an early GTT is offered in clinical practice, adherence rates are still significantly higher than when the test is deferred until the postpartum visit.

Genetics and Epigenetics: Implications for the Life Course of Gestational Diabetes.

Gestational diabetes (GDM) is one of the most common complications of pregnancy, affecting as many as one in six pregnancies. It is associated with both short- and long-term adverse outcomes for the mother and fetus and has important implications for the life course of affected women. Advances in genetics and epigenetics have not only provided new insight into the pathophysiology of GDM but have also provided new approaches to identify women at high risk for progression to postpartum cardiometabolic disease. GDM and type 2 diabetes share similarities in their pathophysiology, suggesting that they also share similarities in their genetic architecture. Candidate gene and genome-wide association studies have identified susceptibility genes that are shared between GDM and type 2 diabetes. Despite these similarities, a much greater effect size for MTNR1B in GDM compared to type 2 diabetes and association of HKDC1, which encodes a hexokinase, with GDM but not type 2 diabetes suggest some differences in the genetic architecture of GDM. Genetic risk scores have shown some efficacy in identifying women with a history of GDM who will progress to type 2 diabetes. The association of epigenetic changes, including DNA methylation and circulating microRNAs, with GDM has also been examined. Targeted and epigenome-wide approaches have been used to identify DNA methylation in circulating blood cells collected during early, mid-, and late pregnancy that is associated with GDM. DNA methylation in early pregnancy had some ability to identify women who progressed to GDM, while DNA methylation in blood collected at 26-30 weeks gestation improved upon the ability of clinical factors alone to identify women at risk for progression to abnormal glucose tolerance post-partum. Finally, circulating microRNAs and long non-coding RNAs that are present in early or mid-pregnancy and associated with GDM have been identified. MicroRNAs have also proven efficacious in predicting both the development of GDM as well as its long-term cardiometabolic complications. Studies performed to date have demonstrated the potential for genetic and epigenetic technologies to impact clinical care, although much remains to be done.

Postpartum Glucose Tolerance Testing Among Patients With Gestational Diabetes During the Coronavirus Disease 2019 Pandemic.

Introduction The impact of the coronavirus disease (COVID-19) COVID-19 pandemic on the care of pregnant patients with gestational diabetes (GDM)is largely unreported. The objective of this study was to compare the completion of postpartum oral glucose tolerance testing (GTT) prior to and during the COVID-19 pandemic among patients with GDM. Methods This was a retrospective review of patients diagnosed with GDM between April 2019 and March 2021. Medical records of patients diagnosed with GDM prior to and during the pandemic were compared. The primary outcome was the difference in the completion of postpartum GTT prior to and during the COVID-19 pandemic. Completion was defined as testing between four weeks to six months postpartum. Secondary objectives were: 1) to compare maternal and neonatal outcomes prior to and during the pandemic among patients with GDM, and 2) to compare pregnancy characteristics and outcomes by compliance with postpartum GTT. Results There were 185 patients included in the study, of whom 83 (44.9%) delivered prior to the pandemic and 102 (55.1%) delivered during the pandemic. There was no difference in completion of postpartum diabetes testing prior,compared to during the pandemic (27.7% vs 33.3%, p=0.47). Postpartum diagnosis of pre-diabetes and type two diabetes mellitus (T2DM) did not differ between groups (p=0.36 and p=1.00, respectively). Patients who completed postpartum testing were less likely to have preeclampsia with severe features compared to patients who did not (OR 0.08, 95% CI 0.01-0.96,p=0.02). Conclusion Completion of postpartum testing for T2DM remained poor prior to and during the COVID-19 pandemic. These findings underscore the need for the adoption of more accessible methods of postpartum testing for T2DM among patients with GDM.

Treatment of Gestational Diabetes Mellitus and Maternal Risk of Diabetes After Pregnancy.

To compare postpartum glucose tolerance between women treated for gestational diabetes mellitus (GDM) and those not treated. Metabolic testing was performed at 3 and 12 months postpartum in 599 women comprising the following gestational glucose tolerance groups: 1) normal glucose challenge test (GCT) and oral glucose tolerance test (OGTT) during pregnancy, 2) abnormal GCT with normal OGTT, 3) gestational impaired glucose tolerance, 4) mild untreated GDM, and 5) severe treated GDM. Birth weight progressively increased across groups 1-4 before falling steeply in treated GDM (P < 0.0001). In contrast, at 3 and 12 months, insulin sensitivity and β-cell function progressively decreased across the five groups, mirrored by rising fasting and 2-h glucose (all P < 0.0001). Accordingly, prevalence of prediabetes/diabetes at 12 months increased in a stepwise manner across groups 1-5 (2.8%, 9.6%, 13.5%, 21.5%, and 32.6%, respectively; P < 0.0001). Treating GDM lowers birth weight but does not disrupt the association between gestational glycemia and maternal prediabetes/diabetes after pregnancy.

Retracted: Analysis and Intervention of Factors Affecting Abnormal Postpartum Glucose Tolerance and Gestational Recurrence in Gestational Diabetes.

[This retracts the article DOI: 10.1155/2021/8470944.].

Prevalence of gestational diabetes and recourse to postpartum oral glucose tolerance test in the Autonomous Province of Trento (Italy)

ObjectiveThe occurrence of gestational diabetes (GDM) is increasing worldwide, and such a diagnosis is important for women's health beyond pregnancy. Therefore, many guidelines suggest the re-evaluation of glucose tolerance with a postpartum oral glucose tolerance test (OGTT) in women with GDM. This study reports the prevalence of GDM and the use of a postpartum OGTT in women assisted at maternity units in the Autonomous Province of Trento in the years 2017–2018, investigating the socio-demographic and health-care variables that can facilitate access to the test. Study designFor the diagnosis of GDM, the International Association of Diabetes and Pregnancy Study Group criteria were used. The Birth Assistance Certificate and the Hospital Information System were used to retrieve clinical and socio-demographic data. Univariate and multivariate analyses were performed to evaluate the stratification of the use of a postpartum OGTT. ResultsIn total, 8,308 pregnant women were assisted at the maternity units in Trento. There were 532 recorded cases of GDM (266 cases per year) and the overall average prevalence was 6.4 % (95 % CI, 5.90–6.90), 4.9 % of whom were Italian (95 % CI, 4.38–5.42) and 10.4 %, foreigners (95 % CI, 9.13–11.67).135 women diagnosed with GDM and residing in Trento out of 513 were evaluated using a postpartum OGTT (26.3%, CI 95% 22.50–30.10), with pathological results in 61 cases (45.2%). In the multivariate analyses, insulin therapy during pregnancy, delivery at a third-level birth point, and a discharge letter informing of the presence of GDM and of the need for a postpartum OGTT were independent factors associated with the probability of carrying out a postpartum OGTT. ConclusionsThe prevalence of GDM in our study is lower than in previous Italian studies; however, it is consistent with European data. The proportion of women who were assessed using the postpartum OGTT is lower than that reported by previous studies. The health-care factors seem predominant among the socio-demographic characteristics of the cases in influencing access to the test. The awareness of women, the sharing of guidelines among the different sectors of the health system, and an optimal management of the discharge from the birth point are critical in ensuring an optimal follow-up in women with GDM.

Predicting Progression from Gestational Diabetes to Impaired Glucose Tolerance Using Peridelivery Data: An Observational Study.

This article aimed to develop a predictive model to identify persons with recent gestational diabetes mellitus (GDM) most likely to progress to impaired glucose tolerance postpartum. We conducted an observational study among persons with GDM in their most recent pregnancy, defined by Carpenter-Coustan criteria. Participants were followed up from delivery through 1-year postpartum. We used lasso regression with k-fold cross validation to develop a multivariable model to predict progression to impaired glucose tolerance, defined as HbA1c≥5.7%, at 1-year postpartum. Predictive ability was assessed by the area under the curve (AUC), sensitivity, specificity, and positive and negative predictive values (PPV and NPV). Of 203 participants, 71 (35%) had impaired glucose tolerance at 1-year postpartum. The final model had an AUC of 0.79 (95% confidence interval [CI]: 0.72, 0.85) and included eight indicators of weight, body mass index, family history of type 2 diabetes, GDM in a prior pregnancy, GDM diagnosis<24 weeks' gestation, and fasting and 2-hour plasma glucose at 2 days postpartum. A cutoff point of ≥ 0.25 predicted probability had sensitivity of 80% (95% CI: 69, 89), specificity of 58% (95% CI: 49, 67), PPV of 51% (95% CI: 41, 61), and NPV of 85% (95% CI: 76, 91) to identify women with impaired glucose tolerance at 1-year postpartum. Our predictive model had reasonable ability to predict impaired glucose tolerance around delivery for persons with recent GDM. · We developed a predictive model to identify persons with GDM most likely to develop IGT postpartum.. · The final model had an AUC of 0.79 (95% CI: 0.72, 0.85) and included eight clinical indicators.. · If validated, our model could help prioritize diabetes prevention efforts among persons with GDM..

Effectiveness of Telemedicine in Managing Diabetes in Pregnancy: A Systematic Review and Meta-Analysis.

Strict monitoring of blood glucose during pregnancy is essential for ensuring optimal maternal and neonatal outcomes. Telemedicine could be a promising solution for supporting diabetes management; however, an updated meta-analysis is warranted. This study assesses the effects of telemedicine solutions for managing gestational and pregestational diabetes. PubMed, EMBASE, Cochrane Library Central Register of Controlled Trials, and CINAHL were searched up to October 14, 2020. All randomized trials assessing the effects of telemedicine in managing diabetes in pregnancy relative to any comparator without the use of telemedicine were included. The primary outcome was infant birth weight. A meta-analysis comparing the mean difference (MD) in birth weight across studies was applied, and subgroup and sensitivity analyses were performed. The revised Cochrane tool was applied to assess the risk of bias, and the certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. From a total of 18 studies, ten (totaling 899 participants) were used to calculate the effect on infant birth weight. The results nonsignificantly favored the control (MD of 19.34 g; [95% confidence interval, CI -47.8; 86.47]), with moderate effect certainty. Heterogeneity was moderate (I2 = 37.39%). Statistically significant secondary outcomes included differences in two-hour glucose tolerance postpartum (gestational diabetes; two studies: standardized mean difference 9.62 mg/dL [95% CI: 1.95; 17.28]) that favored the control (GRADE level, very low) and risk of shoulder dystocia (four studies: log odds -1.34 [95% CI: -2.61; -0.08]) that favored telemedicine (GRADE, low). No evidence was found to support telemedicine as an alternative to usual care when considering maternal and fetal outcomes. However, further research is needed, including economic evaluations.

Postpartum reclassification test in gestational diabetes: can the test be reduced to 1hour?

In gestational diabetes mellitus (GDM), a postpartum oral glucose tolerance test (OGTT) is recommended. However, poor adherence to this procedure has been described, and the time required is one of the reasons. Our aims were to identify predictive factors for abnormal 2-h reclassification OGTT values, including OGTT 1-h glucose, and, if it was a factor, to determine the 1-h cutoff point that best identifies abnormal values at 2h. This was a retrospective study of 769 patients diagnosed with GDM between 2014 and 2019 in a tertiary center. The sample was divided into two groups according to the presence/absence of abnormal 2-h reclassification values, and predictive factors were studied. To determine the 1-h glycemia cutoff point capable of identifying 2-h changes, a ROC curve was drawn and the Youden index was used. The mean age of included women was 33.6 ± 4.95years: 70 of them (9.1%) had an abnormal 2-h test result. Women with a history of GDM (OR = 3.41, p = .012) and higher 1-hglycemia value (OR = 1.05, p < .001) had a higher risk of developing an abnormal 2-h test result. One-hour glycemia ≥ 142mg/dL had a sensitivity of 91.4% and specificity of 75.1% to identify changes in the test at 2h; area under the curve to predict 2-h changes was 0.90 (CI 95%: 0.86 - 0.93). Glucose measurement at 1h predicts alterations at 2h in the reclassification test with excellent diagnostic accuracy, and the cutoff point of ≥ 142mg/dL presents high sensitivity. These findings could serve as a foundation for a possible future redefinition of the OGTT procedure, but further investigation is required.

Postpartum glucose intolerance following early gestational diabetes mellitus

Patients with gestational diabetes mellitus are at increased risk for type 2 diabetes mellitus or glucose intolerance postpartum compared with those without diabetes mellitus. We aimed to evaluate the association between early gestational diabetes mellitus and postpartum dysglycemia compared with gestational diabetes mellitus diagnosed by routine screening in a cohort of patients with obesity. This was a secondary analysis of a randomized controlled trial of patients with obesity and singleton, nonanomalous gestations that compared early gestational diabetes mellitus screening at 14 to 20 weeks of gestation with routine screening at 24 to 28 weeks of gestation. Patients were included in this analysis if they were diagnosed with gestational diabetes mellitus at the primary study site. The primary outcome was postpartum dysglycemia, defined as any abnormality on 2-hour oral glucose tolerance test 6 weeks postpartum or clinical diagnosis based on hyperglycemia requiring pharmacotherapy after delivery with deferred glucose tolerance test. Maternal characteristics and outcomes were compared in bivariable analysis, and logistic regression estimated the association between early gestational diabetes mellitus and postpartum dysglycemia. Of 119 patients included in this analysis, 30 were diagnosed by screening at <20 weeks of gestation and 89 at 24 to 28 weeks of gestation. Patients were overall similar in baseline characteristics. Patients with early gestational diabetes mellitus were more likely to have postpartum dysglycemia than those with gestational diabetes mellitus diagnosed with routine screening (36.7% vs 14.6%; odds ratio, 3.38; 95% confidence interval, 1.31-8.73). Most patients with early gestational diabetes mellitus who had postpartum dysglycemia were diagnosed clinically (n=7/11), whereas none of the patients with gestational diabetes mellitus established by routine testing were diagnosed with postpartum dysglycemia clinically. All (100%) patients with early gestational diabetes mellitus who completed a postpartum glucose tolerance test had dysglycemia compared with only 45% of patients with gestational diabetes mellitus diagnosed on routine screening. The proportion of patients who followed up for postpartum visits and the timing of follow-up were similar between groups. Postpartum glucose tolerance test completion was low but also similar between groups. Although postpartum glucose tolerance test completion is low, patients with gestational diabetes mellitus before 20 weeks of gestation, seem to be at higher risk for postpartum dysglycemia than those with gestational diabetes mellitus diagnosed at routine screening in a cohort of patients with obesity. Larger studies are needed to confirm these findings, but postpartum follow-up and diabetes mellitus testing may be even more important to improve long-term health in patients with early gestational diabetes mellitus.

Implementation of a Postpartum Note Reminder and Factors Associated with Postpartum Glucose Tolerance Screening.

Although reminder systems are used to increase provider adherence, we are not aware of any real-time reminder systems for provider adherence to postpartum glucose tolerance testing. We studied whether a reminder in the electronic medical records affects provider ordering of a postpartum glucose tolerance test. We also studied whether any demographic, medical history, prenatal, or delivery variables are associated with patient attendance to a postpartum visit and patient completion of the postpartum glucose tolerance test when ordered. This was a retrospective study of 246 women diagnosed as having gestational diabetes mellitus who completed prenatal care and delivered at a suburban public safety-net hospital. Implementation of the real-time postpartum note reminder system significantly improved provider adherence to postpartum glucose screening recommendations from 58.1% to 75.0% (P = 0.01). Delivery complications were significantly associated with increased odds for postpartum visit attendance (odds ratio [OR] 3.80, 95% confidence interval [CI] 1.63-8.86, P < 0.01). Increased gestational age at first prenatal visit was significantly associated with decreased odds for postpartum visit attendance (OR 0.93, 95% CI 0.87-0.99, P < 0.05). Speaking Spanish was associated with an increased odds for completion of the postpartum glucose tolerance test when ordered (OR 2.88, 95% CI 1.24-6.70, P = 0.01). We recommend that hospital managers include a reminder system in the electronic medical record. Providers should focus counseling on the potential future risks to the mother, in addition to encouraging continued adherence to postpartum care. Providers also should counsel those who present later to prenatal care about the importance of obtaining postpartum glucose tolerance tests.

Pre-diabetes, diabetes and fluctuations of glucose tolerance after gestational diabetes mellitus: 5-year follow-up of a contemporary, prospective study in Germany.

IntroductionTen years ago, Germany started offering screening for gestational diabetes mellitus (GDM) to all pregnant women. This approach revealed more but also, on average, less severe cases of GDM than the risk-based screening practiced previously. We now examined the incidence of pre-diabetes and diabetes following a GDM diagnosis in the era of universal screening in Germany and compared our results with studies in the previous period. Additionally, we examined the year-to-year fluctuations of glucose tolerance after a pregnancy complicated by GDM.Research design and methodsWe report 5-year follow-up data from 202 women in the prospective, monocenter, postpartum study PPSDiab. Consecutive recruitment took place in Munich, Germany between 2011 and 2016. In the study, we conducted yearly examinations that included anthropometrics, laboratory chemistry and oral glucose tolerance testing.ResultsDuring the first 5 years post partum, 111 (55%) and 12 (6%) of the women developed pre-diabetes and type 2 diabetes, respectively, while 2 (1%) developed type 1 diabetes. Impaired fasting glucose (IFG) was the most common first manifestation of disturbed glucose tolerance, followed by impaired glucose tolerance (IGT), the combination of IFG and IGT, and diabetes. Glucose tolerance did not deteriorate steadily in most women but fluctuated from year to year.ConclusionsIn our analysis, the incidence of diabetes, both type 1 and type 2, after GDM diagnosed in universal screening was substantially lower than in studies from the previous period of risk-based screening. Nevertheless, the high incidence of pre-diabetes we observed after GDM still confirms the importance of this diagnosis as a risk marker. Additionally, we documented frequent fluctuations of glucose tolerance from 1 year to the next. Therefore, a single postpartum glucose tolerance test, as currently practiced in routine care, may be insufficient for reliable risk stratification after GDM.