Postpartum Glucose Tolerance Testing Research Articles

Innovating Diabetes Care in Pregnancy: Do group care models improve outcomes and equity?

Shared medical appointments (SMAs) for diabetes and group prenatal care (GPC) for pregnant patients, have emerged as innovative care delivery models. They have the potential to transform diabetes care by overcoming many of the time limitations of traditional one-on-one clinical visits. There is compelling evidence that SMAs improve glycemic control for non-pregnant patients with diabetes, GPC reduces Black/White health disparities in preterm birth, and Diabetes Group Prenatal Care increase postpartum glucose tolerance test uptake among patients with gestational diabetes mellitus. GPC models standout as one of few interventions that reduce racial health disparities, which we hypothesize occurs because they inadvertently exert their effect on both the patient and clinician through a 20+ hour meaningful shared experience. This Perspective explores the evidence for SMA and GPC in diabetes and pregnancy, theoretical underpinnings of the models, their potential to promote more equitable care, and future directions from my Perspective, as a high-risk obstetrician and 2019 ADA Pathway Accelerator award recipient.

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.

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.

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.

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.

944-P: Gestational Diabetes and Abnormal Glucose Metabolism One Year Postpartum: Clinical Predictive Model vs. 4-12 Week Postpartum Glucose Tolerance Test

A 4-12 week postpartum oral glucose tolerance test (GTT) is recommended for individuals with gestational diabetes mellitus (GDM) to identify those most likely to develop prediabetes and diabetes mellitus, but few people complete this testing. Thus we developed a clinical model at delivery to predict abnormal glucose metabolism at 1 year postpartum (HbA1c ≥ 5.7%) and compared it to the 4-12 week post-partum GTT in a prospectively recruited cohort of women with GDM who were followed for 1 year post-partum (n=203). Using multivariable Lasso regression, we investigated predictor variables available at or before the time of hospital discharge that had biologic plausibility for predicting subsequent abnormal glucose metabolism. We compared the receiver operating curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV, NPV) between the Lasso multivariable model and the 4-12 week GTT to predict HbA1c ≥5.7% at 1 year postpartum. Nine variables were included in the Lasso model achieving an AUC and sensitivity that was better than the GTT at 4-12 weeks (Table). While additional work is needed to validate the model, it appears to better identify individuals at risk for abnormal glucose metabolism at 1 year postpartum than the 4-12 week postpartum GTT. Disclosure E. Werner: None. A. Espinosa dice: None. A. Bengtson: None. Funding American Diabetes Association (1-16-ICTS-118 to E.W.)

107 The association of postpartum glucose and persistent impaired glucose tolerance in women with gestational diabetes

We evaluated the association of fasting glucose values on postpartum day 1 (PPD1) with impaired glucose tolerance (IGT) in patients with gestational diabetes (GDM). We aim to identify a population at risk for IGT who may benefit from improved postpartum follow-up. We conducted a retrospective cohort study of patients with GDM who delivered from 2009-2019 at 2 suburban hospitals. Eligible patients had a singleton pregnancy affected by GDM with complete data on PPD1 fasting glucose and an oral glucose tolerance test (GTT) at 4-12 weeks postpartum. GDM was diagnosed by 50g 1-hour GTT ≥200mg/dL or 3-hour GTT with ≥2 values exceeding defined thresholds. Postpartum IGT was defined as a fasting glucose ≥100mg/dL or 2-hour glucose ≥140mg/dL on postpartum GTT. PPD1 fasting glucose values were divided into three categories (<95, 95-109, and ≥110mg/dL) for analyses. Univariate analyses were performed using Chi-squared, ANOVA, and Wilcoxon rank-sum tests as appropriate to evaluate the association between postpartum IGT and demographic variables, clinical characteristics, and PPD1 glucose by glucose category. Logistic regression models were performed to adjust for variables that were determined a priori and those found to be significant (p<0.05) in univariate analyses. Our analysis included 337 women of which 66.8% had a PPD1 glucose of <95, 21.7% had a PPD1 glucose of 95-109, and 11.5% had a PPD1 glucose ≥110mg/dL. Non-Hispanic white women were more likely have PPD1 glucose values<95 (44.71%, p=0.03) but maternal, demographic, and obstetric characteristics were otherwise not statistically significant between categories (Table 1). 83 patients (24.6%) developed IGT postpartum. In multivariate analysis, as compared to PPD1 glucose 95–109mg/dL: aOR=1.10, 95% CI 0.58-2.07, p=0.77; PPD1 glucose≥110mg/dL: aOR 1.01, 95% CI 0.44-2.30, p=0.99, Table 2). A higher fasting glucose on PPD1 was not significantly associated with IGT at 4-12 weeks postpartum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

199 Postpartum glucose tolerance following early gestational diabetes

Women with GDM are at increased risk for type 2 diabetes (T2DM) or glucose intolerance postpartum. We aimed to compare the risk of postpartum dysglycemia in women with early GDM compared to those with GDM diagnosed in the third trimester. Secondary analysis of a multicenter, randomized controlled trial of obese women with singleton, non-anomalous gestations comparing early GDM screening at 14-20wk to routine screening at 24-28wk. Women were included in this analysis if they were diagnosed with GDM at the primary study site. The primary outcome was postpartum dysglycemia, defined as any abnormality on 2-hour oral glucose tolerance test (GTT) 6 weeks postpartum or clinical diagnosis based on hyperglycemia requiring pharmacotherapy after delivery with deferred GTT. Maternal characteristics and outcomes were compared in bivariable analysis, and logistic regression estimated the association between early GDM and postpartum dysglycemia. Of 119 women included in this analysis, 30 had early GDM and 89 had third trimester GDM. Women with early GDM were more likely to be non-Hispanic Black or White, but other characteristics were similar (Table 1). Women with early GDM were more likely to have clinical diagnosis of dysglycemia with deferred GTT (Table 2). Among the remaining women, GTT completion was low but similar between groups (n=4/23, 17.4% early GDM vs n=29/89, 33% third trimester GDM, p=0.15). All women with early GDM who completed GTT had evidence of dysglycemia compared to 45% of women with third trimester GDM (Table 2). When considering both clinical and laboratory criteria, women with early GDM were more likely to have postpartum dysglycemia compared to women with third trimester GDM (Table 2; OR 3.38, 95% CI 1.31-8.73). While postpartum GTT completion is low, women with early GDM appear to be at higher risk for postpartum dysglycemia compared to women with third trimester GDM. Larger studies are needed to confirm these findings, but postpartum follow-up and diabetes testing may be even more important to impact long-term health in women with early GDM.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

676 Evaluating the utility of the postpartum glucose tolerance test with universal early HbA1c testing

676 Evaluating the utility of the postpartum glucose tolerance test with universal early HbA1c testing

Two-day postpartum compared with 4- to 12-week postpartum glucose tolerance testing for women with gestational diabetes

A majority of women in the United States with gestational diabetes mellitus do not undergo the recommended 4- to 12-week postpartum glucose tolerance test. This study aimed to compare the diagnostic value of the 2-day postpartum glucose tolerance test with the 4- to 12-week postpartum glucose tolerance test to identify impaired glucose metabolism at 1 year after delivery among women with gestational diabetes. Postpartum women who delivered at 1 hospital between January 2017 and July 2018 were offered enrollment in a prospective cohort if they had gestational diabetes mellitus diagnosed by Carpenter-Coustan criteria or a 1-hour glucose challenge test result of ≥200 mg/dL, spoke English or Spanish, and planned to remain in the hospital for at least 2 days after delivery. Participating women underwent a 75-gram 2-hour glucose tolerance test on postpartum day 2 and were incentivized to have a 4- to 12-week glucose tolerance test and measurement of glycosylated hemoglobin at 1 year after delivery. Participants and providers were blinded to the 2-day postpartum results. The diagnostic value of an abnormal 2-day postpartum glucose tolerance test (fasting result of ≥100 mg/dL or 2-hour glucose tolerance test result of ≥140 mg/dL) was compared with that of an abnormal 4- to 12-week glucose tolerance test to identify impaired glucose metabolism (≥5.7% glycosylated hemoglobin) and diabetes (≥6.5% glycosylated hemoglobin) at 1 year after delivery. Receiver operating characteristic (ROC) curves were also compared at 2 days and 4-12 weeks after delivery. Of the 300 recruited women, 296 (99%) completed the 2-day postpartum glucose tolerance test, and 202 (68%) returned for the 4- to 12-week glucose tolerance test. Approximately 1 year after delivery, 203 (68%) women had their glycosylated hemoglobin measured, of whom 35% had impaired glucose metabolism and 4% had diabetes. The study population was diverse (46% nonwhite). Furthermore, 56% were obese (mean body mass index, 32 kg/m2), and 55% had received medication to control their glucose during pregnancy. There were no significant differences between the 2-day and 4- to 12-week postpartum glucose tolerance tests in predicting impaired glucose metabolism based on ≥5.7% glycosylated hemoglobin in 1 year after delivery: sensitivity (46% vs 36%); specificity (79% vs 84%); positive predictive value (52% vs 53%); and negative predictive value (75% vs 72%). There was also no difference between the 2-day and the 4- to 12-week glucose tolerance tests in identifying diabetes at 1 year after delivery. Both the 2-day and 4- to 12-week glucose tolerance tests had similar ROC curves in identifying impaired glucose metabolism and diabetes at 1 year after delivery. Two-day postpartum glucose tolerance tests have similar diagnostic value as 4- to 12-week postpartum glucose tolerance tests in predicting impaired glucose metabolism and diabetes at 1 year after delivery and are associated with nearly 100% adherence to the test. Thus, changing the timing of the glucose tolerance test should be considered.

Improving Maternal and Neonatal Outcomes for Patients With Diabetes by Clinical Navigation [16D

INTRODUCTION: The Louisiana State University Obstetric Clinic (LSU-OBGYN Clinic) developed a navigation system to guide patients with diabetes through their prenatal care. We aimed to determine whether participation in the LSU-Diabetes Navigation System (LSU-DNS) could improve adverse maternal and neonatal outcomes associated with diabetes in pregnancy. METHODS: We conducted a retrospective cohort study of LSU-OBGYN Clinic patients with diabetes in pregnancy (n=191, 10/2015–09/2019; approved and monitored by Woman's Hospital IRB). The primary outcome was occurrence of a maternal-neonatal composite compared in patients before (n=148) or after (n=43) implementation of the LSU-DNS using Fisher exact and Wilcoxon Signed-rank tests. Composite variables included: antepartum admission, preterm delivery, pregnancy-induced hypertension, shoulder dystocia, failure of postpartum glucose tolerance testing, fetal demise, NICU admission, NICU length of stay, neonatal birthweight, large for gestational age, and neonatal hypoglycemia. RESULTS: Since 2015, the maternal-neonatal composite occurred in 112 (58.6%) patients; 89 (60.1%) of patients before the LSU-DNS was implemented and 23 (53.5%) patients that participated in the LSU-DNS (P=.48). While the overall composite is not significantly decreased in LSU-DNS participants in this interim analysis (currently n=43 patients have completed LSU-DNS participation), incidence of several individual outcomes were decreased in LSU-DNS patients compared to pre-LSU-DNS patients including: preterm delivery (21.4% vs. 29.7% respectively, P=.33), pregnancy-induced hypertension (20.1% vs. 26.4%, P=.55), shoulder dystocia (0% vs. 4.1%, P=.33), and large for gestational age neonates (19.0% vs. 23.6%, P=.68). CONCLUSION: The LSU-DNS may improve maternal and neonatal outcomes in patients with diabetes in pregnancy, however more patients are needed to adequately assess its effectiveness.

72: Two day compared to 4-12 week post-partum glucose tolerance testing among women with gestational diabetes

72: Two day compared to 4-12 week post-partum glucose tolerance testing among women with gestational diabetes