Postpartum Diabetes Screening Research Articles

Strategies Associated with Higher Postpartum Glucose Tolerance Screening Rates for Gestational Diabetes Mellitus Patients

Most women with histories of gestational diabetes mellitus do not receive a postpartum screening test for type 2 diabetes, even though they are at increased risk. The objective of this study was to identify factors associated with high rates of postpartum glucose screening. This cross-sectional analysis assessed characteristics associated with postpartum diabetes screening for patients with gestational diabetes mellitus (GDM)-affected pregnancies self-reported by randomly sampled licensed obstetricians/gynecologists (OBs/GYNs) in Ohio in 2010. Responses were received from 306 OBs/GYNs (56.5% response rate), among whom 69.9% reported frequently (always/most of the time) screening women with GDM-affected pregnancies for abnormal glucose tolerance at the postpartum visit. Compared to infrequent screeners, OBs/GYNs who frequently screen for postpartum glucose tolerance were statistically (p<0.05) more likely to have a clinical protocol addressing postpartum testing (67.2% vs. 26.7%), an electronic reminder system for providers (10.8% vs. 2.2%) and provide reminders to patients (16.4% vs. 4.4%). Frequent screeners were more likely to use recommended fasting blood glucose or 2-hour oral glucose tolerance test (61.8% vs. 34.6%, p<0.001) than infrequent screeners. Strategies associated with higher postpartum glucose screening for GDM patients included clinical protocols for postpartum testing, electronic medical records to alert providers of the need for testing, and reminders to patients.

Type 2 Diabetes in Aboriginal Peoples

Type 2 Diabetes in Aboriginal Peoples

Gestational Diabetes Mellitus and Postpartum Care Practices of Nurse‐Midwives

Postpartum screening for glucose intolerance among women with recent histories of gestational diabetes mellitus (GDM) is important for identifying women with continued glucose intolerance after birth, yet screening rates are suboptimal. In a thorough review of the literature, we found no studies of screening practices among certified nurse-midwives (CNMs). The objectives of our study were to estimate the prevalence of postpartum screening for abnormal glucose tolerance and related care by CNMs for women with recent histories of GDM and to identify strategies for improvement. From October through December 2010, the Ohio Department of Health sent a survey by mail and Internet to all licensed CNMs practicing in Ohio. We calculated prevalence estimates for knowledge, attitudes, clinical practices, and behaviors related to postpartum diabetes screening. Chi-square statistics were used to assess differences in self-reported clinical behaviors by frequency of postpartum screening. Of the 146 CNMs who provided postpartum care and responded to the survey (62.2% response rate), 50.4% reported screening women with GDM-affected pregnancies for abnormal glucose tolerance at the postpartum visit. Of CNMs who screened postpartum, only 48.4% used fasting blood sugar or the 2-hour oral glucose tolerance test. Although 86.2% of all responding CNMs reported that they inform women with recent histories of GDM of their increased risk for type 2 diabetes mellitus, only 63.1% counseled these women to exercise regularly and 23.3% reported referring overweight/obese women to a diet support group or other nutrition counseling. CNMs reported that identification of community resources for lifestyle interventions and additional training in postpartum screening guidelines may help to improve postpartum care. CNMs in Ohio reported suboptimal levels of postpartum diabetes testing and use of a recommended postpartum test. Providing CNMs with additional training and identifying community resources to support needed lifestyle behavior change may improve care for women with recent GDM-affected pregnancies.

A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes

We sought to determine whether our process improvement program led to increased postpartum diabetes screening rates among women with gestational diabetes mellitus (GDM). In early 2009, we conducted obstetrics department staff education sessions, revised GDM patient care protocols, and developed an electronic system to trigger reminder calls to patients who had not completed diabetes mellitus screening by 3 months postpartum. We then evaluated the rates of postpartum glucose test order entry and completion for women with GDM delivering from July 2009 through June 2010 (n = 179) and July 2007 through June 2008 (n = 200). After the program's implementation, the proportion of women receiving an order for a postpartum glucose test within 3 months of delivery increased from 77.5-88.8% (P = .004), and test completion increased from 59.5-71.5% (hazard ratio, 1.37; 95% confidence interval, 1.07-1.75). Rates of postpartum diabetes testing can be improved with system changes and reminders.

CA6-01: A System-based Intervention to Improve Postpartum Diabetes Screening Among Women with Gestational Diabetes

Background/Aims Postpartum diabetes screening is recommended for women with gestational diabetes (GDM); up to 36.0% of them will have glucose abnormalities after delivery. To improve the <60% rate of postpartum diabetes screening in Kaiser Permanente Northwest, we conducted a multi- faceted process improvement project.

A physician reminder to improve postpartum diabetes screening in women with gestational diabetes mellitus

AimsWomen with gestational diabetes (GDM) have a 20% risk of developing diabetes in the 10 years following pregnancy, but the risk may be as high as 70% in higher risk populations. Guidelines recommend screening for diabetes postpartum, but screening rates are low. We evaluated the effect of a physician reminder on postpartum screening and in women with GDM. MethodsWe conducted a retrospective chart review among women with GDM seen at our urban, academic endocrine clinic in Toronto, Canada between 2006 and 2010. Our primary outcome was to evaluate the effect of a reminder checklist on postpartum diabetes screening rates. ResultsWe included 314 women in our study, 173 had a checklist on their chart. Women had a mean age of 34.9 years, 45% were Caucasian and 23% had a previous GDM. The checklist was associated with a 3 fold increase in odds of being screened postpartum, and nearly 4 fold increase in postpartum follow up visits (OR 2.99, 95% CI 1.84–4.85 and OR 3.71, 95% CI 2.26–6.11). ConclusionA physician based reminder system is an effective way to improve postpartum screening rates. To further increase screening rates, a multilevel approach targeting both patients and physicians is required.

Postpartum Screening for Diabetes among Medicaid-Eligible South Carolina Women with Gestational Diabetes

PurposeTo examine the rate of timely postpartum screening for diabetes among Medicaid-eligible women with gestational diabetes mellitus (GDM). MethodsWe examined a retrospective cohort of Medicaid women with a live birth between 2004 and 2007. Women with singleton live births at greater than 28 weeks gestation were included in the cohort and their screening receipt tracked. Only the first qualifying pregnancy within the observation period was assessed. Birth certificate records were linked with hospital discharge data, outpatient prenatal care claims to identify women with GDM (n = 6,239). Medicaid postpartum claims for these women were examined to determine receipt of postpartum screening for diabetes within 5 to 13 weeks. Women with any indication of a dedicated plasma glucose test identified by CPT codes 82947, 82950, 82951, and 82952 during this time period were considered to meet the definition of screening. ResultsApproximately 3.4% of women identified as having GDM were screened for diabetes postpartum. Adjusted analysis found women not attending the postpartum visit (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.37–0.91) and women receiving inadequate prenatal care (OR, 0.57; 95% CI, 0.34–0.95) were less likely to receive postpartum screening for diabetes. Conversely, women 20 to 34 years of age (OR, 1.79; 95% CI, 1.21–2.66) and women who were obese (OR, 2.28; 95% CI, 1.56–3.32) were more likely to be screened. ConclusionsMedicaid is a primary source of insurance for many women; however, for most coverage ends at 60 days postpartum, leaving a narrow window of opportunity for postpartum screening. Extended periods of coverage may be beneficial in ensuring the opportunity to receive adequate postpartum care, including screening for diabetes.

Factors affecting attendance at postpartum diabetes screening in women with gestational diabetes mellitus

AbstractUp to 50% of women diagnosed with gestational diabetes mellitus (GDM) will be diagnosed with type 2 diabetes within five years. Attendance rates at postpartum screening are only 48‐56%. As the barriers or facilitators to screening attendance among women diagnosed with GDM have not previously been determined, this study aimed to examine the barriers and facilitators to attendance at postpartum diabetes screening as reported by women following a recent history of GDM.This study was a cross‐sectional telephone survey of Australian women diagnosed with GDM in a Queensland hospital during the period July 2006 to June 2007. Rates of attendance at postpartum diabetes screening were assessed, and reported barriers and facilitators to postpartum screening were grouped into themes.Of 187 eligible participants, 88 women were surveyed (aged 33±6 years, parity 1 [0‐5]). Half (53.4%) of respondents attended postpartum diabetes screening. Barriers to screening included a lack of awareness of the need to attend screening, the inconvenience associated with the two to three hour length of the OGTT, and the need to attend screening with infants and young children. Reported facilitators included improved awareness of the need for screening, multiple reminders, and a more pleasant and convenient test.Facilitation strategies aimed at increasing the awareness of postpartum diabetes risks and promoting the provision of accurate and consistent screening advice from medical providers may assist in improving attendance at postpartum diabetes screening. A more acceptable screening test and establishment of a national database for routine screening reminders may also encourage women to attend postpartum diabetes screening. Copyright © 2011 John Wiley &amp; Sons.

The management of gestational diabetes mellitus after pregnancy

AbstractGestational diabetes mellitus (GDM) is common, with an average prevalence in England and Wales of approximately 3.5%. It is associated with a 70% lifetime risk of developing type 2 diabetes mellitus (T2DM) for the women in the long term. It is therefore important to continue lifelong monitoring for abnormalities of glucose metabolism.There is a lack of international consensus on the best postpartum screening test, its timing, and the frequency and duration of long‐term follow up after GDM. In general, screening rates are suboptimal across the globe with perhaps an optimistic trend in recent years with just over half of the women completing postpartum screening. Postpartum diabetes screening may detect T2DM and enable early treatment of hyperglycaemia, reducing the risk of adverse fetal outcomes in subsequent pregnancies and maternal microvascular complications. Screening can also identify women who might benefit from diabetes prevention interventions. Metformin has been shown to reduce the rate of diabetes development following delivery by 50% and should be considered in all cases of GDM if tolerated. Copyright © 2010 John Wiley &amp; Sons.

Managing women with gestational diabetes mellitus in the postnatal period

Guidelines for management of women with a history of gestational diabetes mellitus (GDM) in the postpregnancy period have lagged behind the recognition that this is an important time for medical intervention. However, in the past decade, the evidence-base for screening algorithms, contraceptive management, diabetes prevention strategies and implications for offspring has expanded. In this review, we discuss current recommendations for managing women with GDM in the postnatal period, with particular attention to postpartum diabetes screening, prevention of future glucose intolerance and family planning.

Postpartum Diabetes Screening

OBJECTIVETo determine the rate of adherence to postpartum glycemic testing in women with gestational diabetes mellitus (GDM) and the performance of fasting plasma glucose (FPG) versus the 75-g oral glucose tolerance test (OGTT) in detecting postpartum glucose intolerance.RESEARCH DESIGN AND METHODSThe study was a retrospective cohort of 1,006 women with GDM attending a pregnancy diabetes clinic.RESULTSPostpartum screening was completed in 438 (48%) women. Women nonadherent to testing had higher parity (1.10 vs. 0.87) and were less likely to require insulin for management of their GDM. Among women who were tested, 89 (21%) had an abnormal result, only 25 (28%) of whom were identified by FPG. Factors associated with abnormal postpartum diabetes screening include non-Caucasian ethnicity, previous GDM, higher A1C, and OGTT values during pregnancy and treatment with insulin.CONCLUSIONSThe rate of postpartum diabetes screening is low, and FPG lacks sensitivity as a screening test in comparison with OGTT.

Effect of dietary pulses on glycaemic control in people with without diabetes: Meta-analyses metaregression models of experimental randomized trials

aims: Because of the high risk for the development of type 2 diabetes after gestational diabetes, clinical practice guidelines recommend screening with an OGTT between 6 weeks and 6 months after delivery for women who had gestational diabetes during pregnancy. The aim of this study was to evaluate trends over time in post-partum screening for diabetes after gestational diabetes. Methods: The study used administrative data sources that provide detailed information on the health care utilisation of all residents of the Canadian province of Ontario (population=12 million). All women aged 17 to 49 without pre-existing diabetes who delivered between April 1994 and March 2008 were identified. Each woman who had gestational diabetes was matched with one who did not on age, region and year/quarter of delivery. For each year/quarter and for each group, the frequency of OGTTs and of any test that might be used to diagnose type 2 diabetes (i.e., OGTT, fasting glucose, random glucose or A1c) was determined up to 6 months post-partum. results: Screening with OGTTs after pregnancy with gestational diabetes increased from between 4 and 7% of pregnancies per year/quarter at the beginning of the study to between 13 and 17% of pregnancies at the end. This markedly exceeded the secular trend seen after pregnancies without gestational diabetes, where screening frequency increased from between 0 and 0.3% of pregnancies at the beginning to between 0.3 and 0.6% of pregnancies at the end. The use of any potential test that might diagnose type 2 diabetes after gestational diabetes increased from between 26 and 28% of pregnancies at the beginning of the study period to between 35 and 40% of pregnancies at the end. conclusion: Although an increasing number of women with pregnancies complicated by gestational diabetes were receiving OGTTs post-partum, the overwhelming majority of women were not receiving these tests. Even when considering a variety of tests that might have been used to diagnose type 2 diabetes, fewer than 40% of women with gestational diabetes were tested. This finding of inadequate screening in a high-risk population suggests that a large number of women of child-bearing age with type 2 diabetes remain undiagnosed.

Trends in Postpartum Diabetes Screening and Subsequent Diabetes and Impaired Fasting Glucose Among Women With Histories of Gestational Diabetes Mellitus

OBJECTIVE—The purpose of this study was to examine trends in postpartum glucose screening for women with gestational diabetes mellitus (GDM), predictors of screening, trends in postpartum impaired fasting glucose (IFG) and diabetes, and diabetes and pre-diabetes detected by postpartum fasting plasma glucose (FPG) versus a 75-g oral glucose tolerance test (OGTT).RESEARCH DESIGN AND METHODS—This was a cohort study of 14,448 GDM pregnancies delivered between 1995 and 2006. Postpartum screening was defined as performance of either an FPG or OGTT at least 6 weeks after delivery and within 1 year of delivery.RESULTS—Between 1995 and 2006, the age- and race/ethnicity-adjusted proportion of women who were screened postpartum rose from 20.7% (95% CI 17.8–23.5) to 53.8% (51.3–56.3). Older age, Asian or Hispanic race/ethnicity, higher education, earlier GDM diagnosis, use of diabetes medications during pregnancy, and more provider contacts after delivery were independent predictors of postpartum screening. Obesity and higher parity were independently associated with lower screening performance. Among women who had postpartum screening, the age- and race/ethnicity-adjusted proportion of IFG did not change over time (24.2 [95% CI 20.0–27.8] in 1995–1997 to 24.3 [22.6–26.0] in 2004–2006), but the proportion of women with diabetes decreased from 6.1 (95% CI 4.2–8.1) in 1995–1997 to 3.3 (2.6–4.0) in 2004–2006. Among women who received an OGTT in 2006, 38% of the 204 women with either diabetes or pre-diabetes were identified only by the 2-h glucose measurements.CONCLUSIONS—Postpartum screening has increased over the last decade, but it is still suboptimal. Compared with FPGs alone, the 2-h values identify a higher proportion of women with diabetes or pre-diabetes amenable to intervention.

Postpartum diabetes screening for women with gestational diabetes: Are we missing an opportunity for prevention?

Postpartum diabetes screening for women with gestational diabetes: Are we missing an opportunity for prevention?

Obstetricians seldom provide postpartum diabetes screening for women with gestational diabetes

We aimed to determine whether obstetrician-gynecologists provided postpartum type 2 diabetes mellitus screening for women with a history of gestational diabetes. We identified women diagnosed with gestational diabetes, and then assessed whether obstetrician-gynecologists provided postpartum diabetes mellitus screening by ordering American Diabetes Association-recommended glucose tests or by referring women to primary care physicians for such testing. Of 2617 gravid women with a 1-hour glucose challenge test, 90 had gestational diabetes and postpartum follow-up. Only 20.0% (18/90) of women with a history of gestational diabetes had documented orders from obstetrician-gynecologists for American Diabetes Association-recommended postpartum diabetes mellitus screening tests. Even when we broadened our definition of "providing postpartum diabetes mellitus screening" to also include referrals to primary care physicians, only 33.3% (30/90) of women met such criteria. Obstetrician-gynecologists at an academic medical center did not provide postpartum diabetes mellitus screening for 66.7% of women with a history of gestational diabetes.

Preventive Counseling Among Women With Histories of Gestational Diabetes Mellitus

The purpose of this study was to examine the association between recall of recommendations for diabetes prevention and both health behaviors and screening among women with histories of gestational diabetes mellitus (GDM). We surveyed 228 women with histories of GDM within the past 5 years who were enrolled in a university-affiliated managed care plan. In a cross-sectional analysis, we assessed the association between recall of health care provider advice and both postpartum lifestyle behaviors and reported performance of postpartum diabetes screening. Multivariate models were constructed that adjusted for correlates of counseling including postpartum diabetes, dyslipidemia, insulin use during pregnancy, and provider type. Participants were predominantly non-Hispanic white, college educated and affluent, and overweight or obese. The majority reported that they received counseling on lifestyle modification and postpartum diabetes screening. Postpartum physical activity levels, fruit and vegetable intake, and screening were suboptimal. No significant association existed between recall of advice and physical activity or between recall of advice and diet. Recall of advice along with distribution of laboratory slips for glucose testing was associated with performance of postpartum diabetes screening using self-report (adjusted odds ratio 2.07 [95% CI 1.51-2.84]) or claims data (1.64 [1.16-2.32]). Women with histories of GDM who recalled advice regarding postpartum glucose testing and received laboratory slips were significantly more likely to report having had postpartum diabetes screening. Although women's recall of services may not reflect the actual services received, simple counseling may not be sufficient to optimize postpartum behaviors to reduce future risk of diabetes.

Recurrence of Gestational Diabetes Mellitus

OBJECTIVE—The purpose of this study was to examine rates and factors associated with recurrence of gestational diabetes mellitus (GDM) among women with a history of GDM. RESEARCH DESIGN AND METHODS—We conducted a systematic literature review of articles published between January 1965 and November 2006, in which recurrence rates of GDM among women with a history of GDM were reported. Factors abstracted included recurrence rates, time elapsed between pregnancies, race/ethnicity, diagnostic criteria, and, when available, maternal age, parity, weight or BMI at the initial and subsequent pregnancy, weight gain at the initial or subsequent pregnancy and between pregnancies, insulin use, gestational age at diagnosis, glucose tolerance test levels, baby birth weight and presence of macrosomia, and breast-feeding. RESULTS—Of 45 articles identified, 13 studies were eligible for inclusion. After the index pregnancy, recurrence rates varied between 30 and 84%. Lower rates were found in non-Hispanic white (NHW) populations (30–37%), and higher rates were found in minority populations (52–69%). Exceptions to observed racial/ethnic variations in recurrence were found in cohorts that were composed of a significant proportion of both NHW and minority women or that included women who had subsequent pregnancies within 1 year. No other risk factors were consistently associated with recurrence of GDM across studies. The rates of future preexisting diabetes in pregnancy, socioeconomic status, postpartum diabetes screening rates after the index pregnancy, and the average length of time between pregnancies were generally not reported. CONCLUSIONS—Recurrence of GDM was common and may vary most significantly by NHW versus minority race/ethnicity.

Postpartum Diabetes Screening in Women With a History of Gestational Diabetes

Women with a history of gestational diabetes mellitus (GDM) are at high risk for developing type 2 diabetes (diabetes mellitus, DM). The American Diabetes Association recommends regular postpartum diabetes screening for women with a history of GDM, but the American College of Obstetricians and Gynecologists (ACOG) is not as directive. We sought to examine postpartum glycemic testing in women diagnosed with GDM. We conducted an observational cohort study of women diagnosed with GDM at one of two large academic medical centers between 2000 and 2001. Kaplan-Meier estimates of the time from delivery to the first postpartum DM screening tests were determined, and predictors of postpartum DM screening were examined using Cox proportional hazards testing. Only 37% of eligible women underwent the postpartum diabetes screening tests recommended by the American Diabetes Association (fasting glucose or oral glucose tolerance test [OGTT]), with a median time from delivery to the first such testing of 428 days. By comparison, 94% of women underwent postpartum cervical cancer screening using a Papanicolaou (Pap) test, with a median time from delivery to Pap testing of 49 days. Even when random glucose testing was included in a broad definition of postpartum DM screening (random or fasting glucose, glycosylated hemoglobin, or OGTT), only two thirds of women (67%) received a postpartum glycemic assessment. In the population studied, only 37% of women with a history of GDM were screened for postpartum DM according to guidelines published by the American Diabetes Association. Efforts to improve postpartum DM screening in this high-risk group are warranted.