Postpartum Glucose Screening Research Articles

Postnatal care after gestational diabetes – a systematic review of clinical practice guidelines

BackgroundGestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research.MethodsWe searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool.ResultsTwenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care.ConclusionsMost of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health.Protocol RegistrationThis review was registered in PROSEPRO (CRD42023454900).

Massachusetts Medicaid ACO Program May Have Improved Care Use And Quality For Pregnant And Postpartum Enrollees.

Value-based care models, such as Medicaid accountable care organizations (ACOs), have the potential to improve access to and quality of care for pregnant and postpartum Medicaid enrollees. We leveraged a natural experiment in Massachusetts to evaluate the effects of Medicaid ACOs on quality-of-care-sensitive measures and care use across the prenatal, delivery, and postpartum periods. Using all-payer claims data on Medicaid-covered live deliveries in Massachusetts, we used a difference-in-differences approach to compare measures before (the first quarter of 2016 through the fourth quarter of 2017) and after (the third quarter of 2018 through the fourth quarter of 2020) Medicaid ACO implementation among ACO and non-ACO patients. After three years of implementation, the Medicaid ACO was associated with statistically significant increases in the probability of a timely postpartum visit, postpartum depression screening, and number of all-cause office visits in the prenatal and postpartum periods, with no changes in severe maternal morbidity, preterm birth, postpartum glucose screening, or prenatal or postpartum emergency department visits. Changes in cesarean deliveries were inconclusive. Results suggest that implementing Medicaid ACOs in the thirty-eight states without them could improve maternal health care outpatient engagement, but alone it may be insufficient to improve maternal health outcomes.

Cross-sectional study examining factors impacting on uptake of postpartum type 2 diabetes screening among women diagnosed with hyperglycaemia in pregnancy

AimsEarly postpartum glucose screening of women with hyperglycaemia in pregnancy (HIP) can identify women who have the highest risk of developing impaired glucose tolerance and T2DM. This study examines the association between demographics, events during pregnancy, socioeconomic status and postpartum T2DM screening. MethodsUsing the French National Health Data System, this cross-sectional study included all deliveries where the mother had HIP in France in 2015, (n = 76,862). The odds ratio (OR) for attending postpartum screening was calculated via multi-level logistic regression. ResultsT2DM screening uptake at six months postpartum was 42·9% [95 % Confidence Interval: 42·6–43·3]. Several characteristics were associated with lower uptake: living in the most deprived area(OR = 0·78[0·74–0·83]); being < 25 years-old (reference age group 25–29;≤17: 0.53 [0·31–0·90];18–24: 0.73[0·69–0·78]); smoking (0·65[0·62–0·68]); obesity (0·93[0·89–0·97]); caesarean delivery (0·95[0·92–0·99]). Factors associated with higher uptake included primiparity (1·30[1·26–1·34]); having followed the French recommendations for HIP screening (1·24[1·20–1·28]); insulin prescription (1·75[1·69–1·81]) and pre-eclampsia (1·30[1·19–1·42]). p < 0.01 is justified due to sample size. ConclusionImproving identification of factors affecting postpartum T2DM screening uptake, such as demographics, socioeconomic context and events during pregnancy, may lead to development of target interventions to aide adherence to screening regime and thereby diagnosis of women with prediabetes or diabetes, for whom secondary and tertiary prevention is crucial.

Postpartum Screening for Type 2 Diabetes Mellitus Among Women With Gestational Diabetes Mellitus at King Abdulaziz University Hospital: A Cross-Sectional Study.

Background Diabetes is characterized by elevated blood glucose levels due to inadequate insulin production or abnormalities in cellular activity. Gestational diabetes mellitus (GDM) is one of the most prominent indicators of type 2 diabetes mellitus (T2DM), which develops in pregnant women whose pancreatic function is insufficient to control the insulin resistance associated with pregnancy. Moreover, it is the most common metabolic disorder, with the majority of cases beginning in the second or third trimester of pregnancy and affecting up to 25% of pregnant women. Objectives The objective of this study was to identify factors associated with postpartum T2DM screening in women with GDM at King Abdulaziz University Hospital (KAUH) between 2010 and 2022. The secondary objective was to assess the factors associated with providing information to the patients about the risks of increased blood glucose and postpartum lifestyle modification. Methods We conducted a retrospective cross-sectional study at KAUH to investigate potential factors associated with postpartum screening for T2DM. Out of 564 patients diagnosed with GDM between 2020 and 2022, we included 200 women aged over 18 years with a history of GDM, as they met the inclusion criteria for our study. Patients younger than 18 years with missing or incomplete baseline characteristics were excluded. Data were analyzed using SPSS Statistics version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.), and p-value <0.05 was considered significant. Results A total of 200 postpartum women with GDM were included in this study. Their mean age was 35.02±5.2 years. Many of them had a family history of diabetes (83.0%) and a previous diagnosis of GDM (60.5%). The patients who performed glucose testing six weeks after birth were previously diagnosed with GDM (37.0%) or with a family history of diabetes (45.5%). The significant variables in this analysis were mothers having frequent postpartum hospital follow-up visits (P<0.001), mothers with gestationalweight gain (P=0.018), those who were informed about the risks of increased blood glucose (P=0.011), and those who were informed about plans for postpartum glucose screening (P=0.002). The motherswith a previous history of GDM were the highest to be informed of the risks of elevated blood glucose. Conclusion Frequent postpartum hospital follow-up visits, gestationalweight gain, knowledge of the risks of elevated blood sugar, and postpartum glucose screening plans were all associated withpostpartum glucose testing rates among women with GDM in Saudi Arabia.

Effect of prenatal counseling on postpartum follow-up and contraceptive use in women with gestational diabetes mellitus: a randomized controlled trial

Postpartum visit attendance for glucose screening and uptake of effective contraception is crucial after a pregnancy with gestational diabetes mellitus (GDM). Although postpartum women with recent GDM are generally advised in the early postnatal period to attend postpartum visits, data have shown suboptimal rates of postpartum glucose testing and highly effective contraceptive use in these women. Compared to the early postnatal period, the antenatal period is when women and healthcare providers have more contact. This may facilitate a better relationship between the pregnant woman and her healthcare providers, thereby improving the women's trust in the providers' counseling. This study aimed to investigate whether adding prenatal counseling to routine early postnatal counseling increases the rates of glucose screening and contraceptive use by 6 weeks postpartum in pregnant women with GDM. A randomized controlled trial including 280 women diagnosed with GDM was conducted. Participants were randomly allocated (1:1, stratified with a permuted block method) to the intervention group (receiving prenatal counseling at 35-36 weeks of gestation plus routine early postnatal counseling) or the control group (receiving only routine early postnatal counseling). The two primary outcomes were glucose screening and highly effective contraceptive uptake by 6 weeks postpartum. The secondary outcome was the use of any contraceptive by 6 weeks postpartum. Data were analyzed according to the intention-to-treat principle. The rate of postpartum glucose screening was 86.4% (121/140) in the intervention group, which was significantly higher than the 50.7% rate (71/140) in the control group (adjusted relative risk [RR], 1.70; 95% confidence interval [CI], 1.27-2.28). The uptake of highly effective contraceptive methods was increased in the intervention group compared to that in the control group (59.3% vs 30.7%; adjusted RR, 1.90; 95% CI, 1.31-2.74). The uptake of any contraceptive method by 6 weeks postpartum was reported by 122 of 140 participants (87.1%) in the intervention group and 77 of 140 participants (55.0%) in the control group (adjusted RR, 1.58; 95% CI, 1.19-2.10). Adding prenatal counseling to routine early postnatal counseling significantly increased the rates of glucose screening and contraceptive use by 6 weeks postpartum in pregnant women with GDM. Given that incorporating counseling regarding postpartum glucose testing and effective contraceptive use into standard prenatal care requires minimal increases in expenditure and manpower, implementation of this counseling strategy in clinical practice seems advisable.

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.

Prevalence and correlates of postpartum glucose screening among women with hyperglycemia in pregnancy in a Nigerian Tertiary Hospital

Prevalence and correlates of postpartum glucose screening among women with hyperglycemia in pregnancy in a Nigerian Tertiary Hospital

Screening for type 2 diabetes after a diagnosis of gestational diabetes by ethnicity: A retrospective cohort study

AimsTo estimate rates and identify determinants of post-partum glucose screening attendance in women with a history of gestational diabetes mellitus (GDM). MethodsRetrospective cohort study using the Clinical Practice Research Datalink linked to Hospital Episode Statistics, to identify women diagnosed with GDM between 01/01/2000 and 05/11/2018. Age adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression models. ResultsIn 10,868 women with GDM, with an average follow-up of 5.38 years (95% CI 5.31,5.45), there was an average of 3.79 (95% CI 3.70,3.89) screening episodes per individual, with a mean time to first screening test of 1.22 (95% CI 1.18, 1.25) years. South Asian women had a significantly greater likelihood of being screened compared to White women within the first 5 years post-partum, aOR: 1.89 95% CI (1.20,2.98). A low proportion of women received at least one test per year of follow-up (23.87%). Older age at GDM diagnosis, polycystic ovary syndrome, prescribed medication for GDM, and living in England, were all associated with a greater likelihood of being screened. ConclusionWhile the majority of women with previous GDM receive at least one glucose screening test within the first 5 years post-partum, fewer than a quarter of them receive on average one test per year of follow-up. Developing strategies to motivate more women to attend screening in primary care is essential.

Machine learning prediction of non-attendance to postpartum glucose screening and subsequent risk of type 2 diabetes following gestational diabetes.

The aim of the present study was to identify the factors associated with non-attendance of immediate postpartum glucose test using a machine learning algorithm following gestational diabetes mellitus (GDM) pregnancy. A retrospective cohort study of all GDM women (n = 607) for postpartum glucose test due between January 2016 and December 2019 at the George Eliot Hospital NHS Trust, UK. Sixty-five percent of women attended postpartum glucose test. Type 2 diabetes was diagnosed in 2.8% and 21.6% had persistent dysglycaemia at 6-13 weeks post-delivery. Those who did not attend postpartum glucose test seem to be younger, multiparous, obese, and continued to smoke during pregnancy. They also had higher fasting glucose at antenatal oral glucose tolerance test. Our machine learning algorithm predicted postpartum glucose non-attendance with an area under the receiver operating characteristic curve of 0.72. The model could achieve a sensitivity of 70% with 66% specificity at a risk score threshold of 0.46. A total of 233 (38.4%) women attended subsequent glucose test at least once within the first two years of delivery and 24% had dysglycaemia. Compared to women who attended postpartum glucose test, those who did not attend had higher conversion rate to type 2 diabetes (2.5% vs 11.4%; p = 0.005). Postpartum screening following GDM is still poor. Women who did not attend postpartum screening appear to have higher metabolic risk and higher conversion to type 2 diabetes by two years post-delivery. Machine learning model can predict women who are unlikely to attend postpartum glucose test using simple antenatal factors. Enhanced, personalised education of these women may improve postpartum glucose screening.

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.

Strategies to improve postpartum glucose screening rates are needed.

Women with gestational diabetes mellitus (GDM) require postpartum glucose screening, as they have a 70% lifetime risk of developing Type 2 diabetes mellitus. However, less than half complete postpartum screening. We conducted a retrospective chart review of patients who delivered at our institution from 2001 to 2019. Inclusion criteria were patients with gestational diabetes who were at least 18 years old and had delivered an infant at >24 weeks of gestation. Our primary outcome was completion of postpartum gestational diabetes screening. The majority of patients (62%) did not complete screening. After adjusted risk ratio analyses, the only variables that remained significantly associated with an increased likelihood of completing screening were Asian race and having prenatal care at one particular community health center, which served a predominantly Asian population. This community health center protocol for scheduling patients with GDM that complied with recommendations for postpartum care, indicating that evidence-based methods can improve maternal health.

Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views

BackgroundGestational diabetes mellitus (GDM) is an important risk factor for developing type 2 diabetes mellitus (T2DM) later in life. Postpartum screening provides an opportunity for early detection and management of T2DM, but uptake is poor.AimTo explore barriers to screening from clinicians’ perspectives to guide future interventions to increase uptake of postpartum screening.Design and settingSystematic review and qualitative synthesis.MethodQualitative studies included in a previous review were assessed, and then five electronic databases were searched from January 2013 to May 2019 for qualitative studies reporting clinicians’ perspectives on postpartum glucose screening after GDM. Study quality was assessed against the Critical Appraisal Skills Programmes checklist. Qualitative data from the studies were analysed using thematic synthesis.ResultsNine studies were included, containing views from 187 clinicians from both community and hospital care. Three main themes were identified: difficulties in handover between primary and secondary care (ambiguous roles and communication difficulties); short-term focus in clinical consultations (underplaying risk so as not to overwhelm patients and competing priorities); and patient-centric barriers such as time pressures.ConclusionBarriers to diabetes screening were identified at both system and individual levels. At the system level, clarification of responsibility for testing among healthcare professionals and better systems for recall are needed. These could be achieved through registers, improved clinical protocols, and automatic flagging and prompts within electronic medical records. At the individual level, clinicians should be supported to prioritise the importance of screening within consultations and better educational resources made available for women. Making it more convenient for women to attend may also facilitate screening.

Postpartum glucose screening among women with gestational diabetes

Objective(1) Determine the rate of completion of glucose screening for diabetes in the postpartum period for women who had gestational diabetes mellitus, and (2) compare the rates of follow up glucose screening among women who had A1GDM or A2GDM 4-12 weeks postoartum. DesignA retrospective comparative study. SettingAn academic hospital in an urban community. ParticipantsOne hundred and seventy-five women with gestational diabetes who gave birth between January 2012 and September 2015. MethodsThe electronic medical record was reviewed to confirm diagnosis of gestational diabetes at 24–28 weeks and completion of 4–12 weeks postpartum glucose screening. All consecutive women meeting eligibility criteria were included. ResultsThe rate of postpartum glucose screening was 38.9%. There were 22 (31.0%) women with A1GDM and 46 (44.2%) women with A2GDM who had postpartum glucose screening (χ2 = 3.12, p = 0.08). ConclusionsThe type of GDM, did not affect the rate of follow-up for postpartum glucose screening. Strategies need to be developed to improve postpartum screening rates in women with gestational diabetes.

Factors influencing postpartum blood glucose screening among women with prior gestational diabetes mellitus in a rural community.

The aims of the present study were: a) to investigate the current state of postpartum glucose screening in rural China; and b) to explore the factors influencing postpartum blood glucose screening among women with prior GDM based on Andersen's behavioural model of health service use. A multisite, cross-sectional study design, conducted from November 2017 to January 2018. A total of 465 women with prior GDM were included from two county-level hospitals in rural China. The potential influencing factors for postpartum blood glucose screening based on Andersen's behavioural model, including predisposing, enabling, and need factors, were collected by self-reported questionnaires. Chi-square tests and logistic regression were used to explore the influence of these factors on whether screening of blood glucose level after delivery occurred. The mean age of the women was 31.92years old (SD 5.16) and the mean time after delivery was 16.73months (SD 15.07). The postpartum glucose screening proportion was 32.7%. Women who did not have a full-time job (p= .011) (predisposing factor), had not received any treatment for GDM (p= .002), and were not informed about screening plans for diabetes by health professionals (p < .001) (enabling factor) were less likely to engage in postpartum glucose screening. The need factor, high actual risk of developing type 2 diabetes mellitus (T2DM), was not associated with postpartum blood glucose screening (p> .05). In rural China, most women with prior GDM were not screened for T2DM after delivery. The women with prior GDM who did not have a full-time job or had not received any prior treatment for GDM should be the target population for health education on postpartum glucose screening. There is a need for data on postpartum blood glucose testing rates among rural women. Future interventions aimed at increasing postpartum blood glucose screening are needed.

Gestational diabetes: screening uptake, current challenges and the future – a focused review

The increased risk of developing type 2 diabetes mellitus (T2DM) in women with a history of previous gestational diabetes mellitus (GDM) has been established and is well recognised. Post-partum screening for T2DM is essential to identify those at higher risk and allow for the implementation of preventative interventions. However, attendance rates for post-partum glucose screening in women with previous GDM remain substantially low, with only half of them attending screening. This review aimed to outline the National Institute for Health and Care Excellence (NICE) post-partum screening recommendations and compare them with the guidelines being used worldwide, provide information on post-partum screening uptake and possible determinants of uptake in the UK, and to briefly discuss both patient health implications and the financial burden associated with T2DM progression in the context of the National Health Service (NHS).

114: Disparities in postpartum glucose screening in a large tertiary center with respect to socioeconomic factors

Per current recommendations, all women diagnosed with gestational diabetes mellitus (GDM) should undergo a 2-hour glucose challenge test postpartum to determine persistence of disease. The aim of this study was to determine the frequency of GDM postpartum guideline adherence among providers and patients in accordance with socioeconomic factors in a tertiary care center in Houston, TX. In a retrospective review, charts of women who delivered at Texas Children’s Hospital Pavilion for Women from 1/1/2016 to 12/31/2017 were analyzed for significance according to demographics, insurance status, prenatal diagnosis of GDM, and completion of the postpartum 2-hour GTT. Of 17,705 women who delivered, 691 (3.9%) were diagnosed with GDM using the standard 1-hour GTT followed by the 3-hour GTT per Carpenter-Coustan criteria. Of the 691 women, 98% (n=612) were insured. Of these, 55% (n=194) completed the postpartum GTT ordered by their provider at hospital discharge or during the routine postpartum visit. There was no significant difference in provider ordering patterns between insured and uninsured women (p=0.5). However, uninsured women were significantly less likely to complete the postpartum GTT ordered by their provider (p=0.001). No significant difference in insurance status was observed between White non-Hispanic and White Hispanic women in whom the postpartum GTT was ordered and completed (p=0.6). However, regardless of insurance status, Black women were significantly less likely to complete the postpartum GTT compared to White non-Hispanic and White Hispanic women (p=0.01 and p=0.04 respectively). Other racial groups were not analyzed due to the small percentage of GDM patients in this cohort. Independent of insurance status, providers at this tertiary care center ordered the postpartum GTT for only 32% of women prenatally diagnosed with GDM. Black women were significantly less likely to complete the postpartum GTT, even when ordered appropriately. Quality efforts to improve postpartum care for this population is critical due to the high-risk for incomplete follow-up.

404: Postpartum diabetes screening in an urban resident clinic

Gestational diabetes mellitus (GDM) affects an estimated 7% of pregnancies and increases the risk for type 2 diabetes. Recommendations include screening all women with GDM with a 75g 2-hour oral glucose tolerance test (OGTT) 4-12 weeks postpartum. Nationwide more than 40% of women do not present for postpartum care, and postpartum glucose screening rates range from 3% to 50% across the United States. The primary objective of our study was to analyze rates of compliance with postpartum diabetic screening in a high risk resident clinic. Secondary objectives were to assess postpartum care rates and factors that may influence follow up. We conducted a retrospective chart review of all women who received prenatal care at a single resident clinic within an urban Federally Qualified Health Center from January 1, 2014 to December 31, 2018. Women without documented antepartum gestational diabetic screening or delivery information were excluded. Variables analyzed included demographics, obstetrical and medical history, adequacy of prenatal care, and substance abuse. Statistical analysis was performed using SPSS version 24.0. A total of 952 patients were included in the study. 4.3% (n=41) were diagnosed with GDM. 73% (n=33) of women with GDM presented for postpartum care. Only 40% (n=12) had a 2-hour OGTT ordered, in which 75% (n=9) completed the testing. All women who completed postpartum screening had normal results. 72.0% (n=685) of our entire study population returned for postpartum care. Race (p< 0.01), gravidity (p< 0.01), parity (p< 0.01), mode of delivery (p< 0.01), adequacy of prenatal care (p< 0.01), and substance abuse (p< 0.01) were significantly associated with postpartum follow up. The majority of women with GDM did not have a 2-hour OGTT ordered by their prenatal provider. However, rates of postpartum follow up were above the national average in this clinic. While patient-driven strategies are important, provider-driven strategies, including education, check lists, and electronic medical record prompting, should be implemented to improve screening rates.

1415-P: Gestational Diabetes Mellitus after Delivery: The Need for Continued Vigilance

Despite guideline recommendations, there are currently limited data on the extent and yield of repeat postpartum glucose testing of women with gestational diabetes mellitus (GDM). Accordingly, we examined these issues in a large population-based cohort of women in Alberta, Canada, who gave birth between 10/01/2008-06/30/2013, were diagnosed with GDM, and followed-up until 12/31/2015 (n=10520). The study population included the 4625 (44%) women who underwent glucose testing within 6 months (m) after delivery. Laboratory data were used to identify rates of repeat testing between 6-18 m postpartum. Diabetes Canada thresholds were used to identify women who converted to diabetes mellitus (DM). A total of 211 (4.6%) women had overt DM, i.e., DM within 6 m of delivery. Among 4414 women with GDM who had a normal glucose test within 6 m, 1656 (37.5%) underwent repeat testing between 6-18 m. Of these, 77 (4.6%) were diagnosed with DM. This latter group was older, more likely multiparous, had higher rates of gestational hypertension and C-section, more likely to have been on insulin therapy during pregnancy, and had the highest rates of large for gestational age (LGA) babies (Table). While early postpartum glucose screening is likely to identify women with overt diabetes, continued monitoring, despite initial normal screens, is necessary to ensure early detection of DM and other chronic disease in women with GDM. Disclosure P. Kaul: None. A. Savu: None. L.E. Moore: None. R.O. Yeung: Advisory Panel; Self; Sanofi. Consultant; Self; Novo Nordisk Inc. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Novo Nordisk Inc., Sanofi. E.A. Ryan: None. Funding Canadian Institutes of Health Research

Glucose screening within six months postpartum among Chinese mothers with a history of gestational diabetes mellitus: a prospective cohort study

BackgroundGestational diabetes mellitus (GDM) is a risk factor for diabetes mellitus. The 75-g, 2-h oral glucose tolerance test is recommended for mothers with a history of GDM to screen for diabetes in the postnatal period. The aim of this study was to investigate the rate of glucose screening within 6 months postpartum among Chinese mothers with a history of GDM, and to identify its predictors.MethodsA prospective cohort study was conducted in a regional teaching hospital in Guangzhou, China, between July 2016 and June 2017. The participants were Chinese mothers (n = 237) who were diagnosed with GDM, were aged 18 years or older with no serious physical or mental disease and had not been diagnosed with type 1 or type 2 diabetes prior to their pregnancy. The revised Chinese version of the Champion’s Health Belief Model Scale and social-demographic and perinatal characteristics factors were collected and used to predict postpartum glucose screening (yes or no). Adjust odds ratio (AOR) and 95% confidence interval (95% CI) were calculated.ResultsThe mean age of the 237 mothers was 32.70 years (range from 22 to 44). Almost half of the mothers (45.6%) were college graduates or higher. Chinese mothers reported a high level of perceived benefits, self-efficacy, and health motivation towards postpartum glucose screening, with a mean score above 3.5.Chinese mothers were more likely to undertake postpartum glucose screening if they were a first-time mother [AOR 2.618 (95% CI: 1.398–4.901)], had a high perceived susceptibility score [AOR 2.173 (95% CI: 1.076–4.389)], a high perceived seriousness score [AOR 1.988 (95%CI: 1.020–3.875)] and high perceived benefits score [AOR 2.978 (95%CI: 1.540–5.759)].ConclusionThe results of this study will lead to better identification of mothers with a history of GDM who may not screen for postpartum glucose abnormality. Health care professionals should be cognizant of issues that may affect postpartum glucose screening among mothers with a history of GDM, including parity, perceived susceptibility, perceived seriousness and perceived benefits.

Abstract MP49: Racial/Ethnic Differences in Receipt of Follow-up Care and Type 2 Diabetes Diagnosis Following Gestational Diabetes

Introduction: Gestational diabetes mellitus (GDM) affects up to 14% of pregnancies in the U.S. and is associated with a sevenfold increased lifetime risk for type 2 diabetes (T2D). Clinical guidelines recommend postpartum glucose screening 4-12 weeks after a GDM pregnancy, and re-screening every 1-3 years thereafter. However, an inadequate proportion of persons with GDM actually receive these screenings. Racial/ethnic differences in risk of developing T2D following GDM may partially be driven by differential receipt of screening services. The aim of this study was to examine racial/ethnic differences in subsequent development of T2D, receipt of screening services, and glycated hemoglobin (HbA1c) in a nationally representative sample of women with a GDM history. Methods: We analyzed data from the National Health and Nutrition Examination Survey (NHANES, 2007-2014). Race/ethnicity, GDM and diabetes diagnosis, and receipt of diabetes screening tests were determined by self-report; HbA1c was measured using standard laboratory procedures. Associations of race/ethnicity with outcomes of interest were evaluated using linear, logistic, and Cox regression, with adjustment for demographic, clinical, and healthcare access factors. Results: Among 629 women with a history of GDM in NHANES, non-Hispanic Black women had 98% higher risk (95% CI (1.28, 3.08), p=0.003), and Hispanics about double the risk (HR = 2.04, 95% CI (1.25, 3.32), p=0.005) of developing T2D following GDM compared to non-Hispanic Whites. In fully adjusted models, this was attenuated slightly, although still statistically significantly greater risk for both non-Hispanic Black (p=0.05) and Hispanic (p=0.03) women. Both non-Hispanic Black and Hispanic women were less likely to report being screened for diabetes in the past 3 years. In adjusted linear regression models, among women who remained diabetes-free, non-Hispanic Blacks had 0.40-% point higher HbA1c (p=0.02), and Hispanics had 0.26-% point higher HbA1c (p&lt;0.001) compared to non-Hispanic Whites. Additionally, the odds of prediabetes were 4.9-fold higher for non-Hispanic Blacks (p&lt;0.001), and 2.4-fold greater for Hispanics (p=0.03) as compared to non-Hispanic Whites. Odds of undiagnosed diabetes (HbA1c&gt;6.5%) were significantly higher in non-Hispanic Blacks (OR=3.3, p=0.05) and marginally greater in Hispanics (OR=3.5, p=0.07) compared to non-Hispanic Whites. Conclusions: Differential receipt of follow-up services by minority women may exacerbate observed disparities in the burden of T2D. In this study, racial/ethnic disparities were apparent with regards to T2D diagnosis, receipt of diabetes screening tests, and HbA1c. Additional investigation to identify underlying factors contributing to this observed disparity will be particularly important to inform recommendations to improve delivery of quality care equitably across population subgroups.