Postpartum Testing Research Articles

Postpartum glucose tolerance status 6 to 12 weeks after gestational diabetes mellitus: a Brazilian cohort

The aims of this study were to estimate the local rate of postpartum diabetes screening after gestational diabetes mellitus (GDM) pregnancies, and to identify clinical variables associated with retesting rates and with the persistence of decreased glucose tolerance. Prospective cohort of GDM women with prenatal delivery at a specialized center, from November 2009 to May 2012. All women were advised to schedule a 6 weeks postpartum 75-g oral glucose tolerance test (OGTT). Of the 209 women included, 108 (51.7%) returned to be tested with fasting plasma glucose (n=14), OGTT (n=93) or random glucose (n=1). Return was associated with lower parity rate (2 vs. 3, p<0.001) and higher pregnancy 2-h OGTT (165 vs. 155 mg/dL, p=0.034), but not with socio-demographic characteristics. Four women (3.7%) had diabetes, 22 (20.4%) had impaired fasting glucose or impaired glucose tolerance. Persistent hyperglycemia was associated with a positive family history of diabetes (relative risk-RR 2.41, p=0.050), diagnostic 2-h OGTT in pregnancy (RR 1.01, p=0.045), insulin use during pregnancy (RR 2.37, p=0.014), and cesarean section (RR 2.61, p=0.015). Even though postpartum abnormalities were frequent in GDM, rates of postpartum diabetes screening were undesirably low. As no specific clinical profile defines who will adhere to postpartum testing, it is essential to encourage all women to reevaluate their glucose status, particularly those with a family history of diabetes and more severe hyperglycemia.

Maternal Hemodynamics by Thoracic Impedance Cardiography for Normal Pregnancy and the Postpartum Period

To establish normative impedance cardiography values for the second half of pregnancy and up to 48 hours postpartum after either vaginal or cesarean delivery. A single-center prospective observational institutional review board-approved study of normotensive women (n=168) using thoracic impedance cardiography performed at specific times during gestation. Antepartum testing was performed at three time periods: 20-27 weeks, 28-33 weeks, and 34-40 weeks of gestation. Postpartum testing was undertaken after the immediate puerperium at 6-23 hours and 24-48 hours after vaginal or cesarean delivery. Data analysis was performed using STATA software; data are expressed as mean±standard deviation. All seven of the patient groups studied were comparable with regard to demographic features; 80% of the study participants were African American. Group means obtained between 20 and 40 weeks of gestation and postpartum after vaginal and cesarean delivery fell within the "normal range" of the hemodynamic graph that was developed to associate mean arterial pressure and systemic vascular resistance. The thoracic fluid content group means in both vaginal and cesarean delivery groups were higher than the antepartum patient groups. The thoracic fluid content mean after cesarean delivery at 48 hours is significantly higher than the mean value recorded between 20 and 27 weeks of gestation (P<.05). The systemic vascular resistance systemic vascular resistance means in each of the postpartum groups were significantly higher than the late second-trimester group means recorded at 20-27 weeks of gestation (P<.05). The normative values reported in this investigation can be used to interpret and assess similarly tested patients with hypertensive or otherwise complicated pregnancy. III.

Impact of an intensive follow-up program on the postpartum glucose tolerance testing rate

Gestational diabetes mellitus (GDM) is a strong risk factor for the development of diabetes. We assessed the impact of a 1-year intensive follow-up demonstration program, using direct nurse and outreach worker case management, aimed at increasing compliance with postpartum oral glucose tolerance testing (OGTT). During the year of implementation, a nurse or bilingual outreach worker contacted patients to encourage attendance at their scheduled postpartum 2-h 75-g OGTT and assisted in overcoming obstacles to testing. All patients with GDM seen in our specialty clinic the previous year served as a control group for comparison. One hundred eighty-one patients treated during the year prior to implementation were compared to the 207 in the demonstration program. Baseline characteristics were similar in both groups. After the program's implementation, postpartum OGTT adherence increased from 43.1 to 59.4 % (p < 0.01, hazard ratio 1.59; 95 % confidence interval 1.20-2.12). Had the program been in place the previous year, we calculated that 12 additional cases of diabetes or prediabetes would have been detected, increasing the total number from 33 to 45 such cases. Implementation of direct nurse and outreach worker case management leads to a modest, but important increase in adherence to postpartum OGTT testing.

Diabetes screening after gestational diabetes in England: a quantitative retrospective cohort study

The National Institute for Health and Care Excellence (NICE) recommends postpartum and annual monitoring for diabetes for females who have had a diagnosis of gestational diabetes mellitus (GDM). To describe the current state of follow-up after GDM in primary care, in England. A retrospective cohort study in 127 primary care practices. The total population analysed comprised 473 772 females, of whom 2016 had a diagnosis of GDM. Two subgroups of females were analysed using electronic general practice records. In the first group of females (n = 788) the quality of postpartum follow-up was assessed during a 6-month period. The quality of long-term annual follow-up was assessed in a second group of females (n = 718), over a 5-year period. The two outcome measures were blood glucose testing performed within 6 months postpartum (first group) and blood glucose testing performed annually (second group). Postpartum follow-up was performed in 146 (18.5%) females within 6 months of delivery. Annual rates of long-term follow-up stayed consistently around 20% a year. Publication of the Diabetes in Pregnancy NICE guidelines, in 2008, had no effect on long-term screening rates. Substantial regional differences were identified among rates of follow-up. Monitoring of females after GDM is markedly suboptimal despite current recommendations.

321: Rates of postpartum glucose testing following gestational diabetes mellitus and factors affecting compliance to testing

321: Rates of postpartum glucose testing following gestational diabetes mellitus and factors affecting compliance to testing

Evaluation of home testing to improve follow up after gestational diabetes (Fingerstick Assessments of Sugar Two-months postpartum or FAST).

Historically the rates of postpartum glucose tolerance testing for women with gestational diabetes (GDM) average a suboptimal 33%. Barriers include the need for new mothers to miss work and/or arrange for childcare in order to engage in a two-hour test at a commercial lab. This pilot study was initiated to test the theory that a home testing regimen would be accepted by patients and increase the rate of postpartum glucose assessments relative to published rates, without requiring additional health-care staff or resources to achieve this goal. Six weeks postpartum, women with GDM from an academic private practice were asked to check fingerstick blood glucose (FAST Protocol) four times a day for two days, and then obtain an oral glucose tolerance test (OGTT). The physician consultants saw the women each month during pregnancy and arranged the postpartum testing. Two of 69 refused to be consented. Twelve of the remaining 67(18%) women completed both the FAST regimen and the OGTT, three completed only the OGTT and five completed only the FAST regimen for a final follow-up rate of 20/67 (30%). The demands of caring for a newborn, or the annoyance of fingersticks, were barriers to compliance. In spite of intense physician involvement, this home testing regimen was not associated with an increase in the rates of women participating in postpartum glucose assessments.

Use of Glycated Hemoglobin and Waist Circumference for Diabetic Screening in Women With a History of Gestational Diabetes

ObjectiveAlthough their risk of type 2 diabetes is markedly increased, women with prior gestational diabetes mellitus (GDM) do not receive appropriate testing following their pregnancy. Identifying a less burdensome testing method might increase postpartum testing rates. Our objective was to examine the adequacy of glycated hemoglobin (A1C) and waist circumference (WC) measurements to detect impaired glucose metabolism among women with prior GDM. MethodsThe analysis included 178 women who had GDM between 2003 and 2010. WC and A1C were measured, and a 75g 2h-OGTT was performed. Pre-diabetes was defined as a fasting plasma glucose (FPG) ≥ 5.6 and < 7.0mmol/L or a 2-hour plasma glucose (2h-PG) ≥ 7.8 and < 11.0mmol/L, and type 2 diabetes was defined as a FPG ≥ 7.0mmol/L and/or a 2h-PG ≥ 11.1mmol/L. Sensitivity and specificity analyses were performed. ResultsThe mean age of subjects was 36.4 ± 4.8 years, and testing occurred at a mean 3.5 ± 1.9 years following delivery. Combining A1C ≥ 5.7% and WC ≥ 88cm to detect pre-diabetes had a sensitivity of 76% and specificity of 62%, and to detect type 2 diabetes it had a sensitivity of 91% and specificity of 34%. Compared with women who had A1C and WC within the normal range, women with A1C ≥ 5.7% and WC ≥ 88cm were more likely to have type 2 diabetes (OR 4.4; 95% CI 2.0 to 9.9). ConclusionThese analyses suggest that the combination of A1C and WC could represent a sensitive test for pre-diabetes and type 2 diabetes in the years following a pregnancy complicated by GDM. Further validation of this testing method is required.

Predictors of Postpartum Glucose Tolerance Testing in Italian Women with Gestational Diabetes Mellitus

Postpartum screening is critical for early identification of type 2 diabetes in women previously diagnosed with gestational diabetes mellitus (GDM). Nevertheless, its rate remains disappointingly low. Thus, we plan to examine the rate of postpartum glucose tolerance test (ppOGTT) for Italian women with GDM, before and after counseling, and identify demographic, clinical, and/or biochemical predictors of adherence. With these aims, we retrospectively enrolled 1159 women with GDM, in Calabria, Southern Italy, between 2004 and 2011. During the last year, verbal and written counseling on the importance of followup was introduced. Data were analyzed by multiple regression analysis. A significant increase of the return rate was observed following introduction of the counseling [adjusted odds ratio (AOR) 5.17 (95% CI, 3.83–6.97), P < 0.001]. Interestingly, previous diagnosis of polycystic ovary syndrome (PCOS) emerged as the major predictor of postpartum followup [AOR 5.27 (95% CI, 3.51–8.70), P < 0.001], even after stratification for the absence of counseling. Previous diagnosis of GDM, higher educational status, and insulin treatment were also relevant predictors. Overall, our data indicate that counseling intervention is effective, even if many women fail to return, whereas PCOS represents a new strong predictor of adherence to postpartum testing.

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.

Postpartum Diabetes Testing Among Women with Recent Gestational Diabetes Mellitus: PRAMS 2009–2010

The objective of this study was to estimate rates of and factors associated with postpartum diabetes testing in women with recent gestational diabetes mellitus (GDM). Secondary data analysis was conducted using data from the 2009 and 2010 Pregnancy Risk Assessment Monitoring System from three states and one city (Colorado, Minnesota, Utah, and New York City). Frequency of postpartum diabetes testing was estimated overall and among women who attended a postpartum visit. Multivariable logistic regression was used to determine factors associated with postpartum diabetes testing. Approximately 8.2% [95% confidence interval (CI) 7.5-8.9] of women self-reported a history of GDM (n = 829), of which 48.5% (43.9-53.1) reported being tested for diabetes postpartum. Among the 90.0% (86.5-93.4) of women with recent GDM who attended the postpartum visit, 51.7% (46.1-57.2) reported being tested for diabetes postpartum. Women who received inadequate/intermediate prenatal care were half as likely to report postpartum testing compared with women who received adequate prenatal care [odds ratio 0.45 (95% CI 0.25-0.83)]. Women with a prepregnancy body mass index classified as obese were over twice as likely to report postpartum testing compared to normal weight women. Women with GDM are at increased risk of persistent glucose intolerance after delivery, yet postpartum testing rates remain around 50%, regardless of attendance to the postpartum visit. Improving adequacy of prenatal care might further increase postpartum testing rates. Continued efforts to translate postpartum testing into practice are needed among these women at risk for future type 2 diabetes.

Incidence of Postpartum Diabetes and Glucose Intolerance among Filipino Patients with Gestational Diabetes Mellitus seen at a Tertiary Hospital

Objective. Women with gestational diabetes mellitus (GDM) are at increased risk to develop type 2 diabetes. This study aims to determine the incidence of postpartum diabetes and/or glucose intolerance among Filipino GDM patients who delivered at a tertiary hospital in Manila and to compare the risk factors present among these women. Methodology. 173 Filipino patients were included in this 3-year prospective cohort study. Demographics, clinical variables, and feto-maternal outcomes were recorded. 124 patients returned for follow-up and postpartum glycemic status was determined using 75g oral glucose tolerance test. Results. The incidence of diabetes and prediabetes postpartum was 7.3% and 34.7% respectively. Logistic regression analysis showed that multigravid patients (OR=2.84; 95% CI 1.20,6.70) and those with postpartum obesity (OR=2.84; 95% CI 1.20,6.70) are more likely to have prediabetes. Diagnosis of GDM at an earlier trimester increases the odds of having postpartum diabetes (OR=3.05; 95% CI 1.02,9.18). Also, if the body mass index falls under obese class II postpartum, the probability increases 115 times (95% ci 3.96,3357.83; p=0.006). Conclusion. The incidence of postpartum glucose intolerance among Filipino women with GDM is high. Clinicians should be more vigilant and strategies to implement compliance to postpartum glucose testing must be formulated to increase rates of follow-up testing among these women.

The DIAMIND study: postpartum SMS reminders to women who have had gestational diabetes mellitus to test for type 2 diabetes: a randomised controlled trial – study protocol

BackgroundPostpartum follow up of women who have been found to have gestational diabetes during pregnancy is essential because of the strong association of gestational diabetes with subsequent type 2 diabetes. Postal reminders have been shown to increase significantly attendance for oral glucose tolerance testing postpartum. It is possible that a short message service (text) reminder system may also be effective. This trial aims to assess whether a text message reminder system for women who have experienced gestational diabetes in their index pregnancy will increase attendance for oral glucose tolerance testing within six months after birth.Methods/DesignDesign: Single centre (Women’s and Children’s Hospital, South Australia), parallel group randomised controlled trial.Inclusion criteria: Women diagnosed with gestational diabetes in their index pregnancy (oral glucose tolerance test with fasting glucose ≥ 5.5 mmol/L and/or two hour glucose ≥ 7.8 mmol/L), with access to a mobile phone, whose capillary blood glucose profile measurements prior to postnatal discharge are all normal (fasting glucose < 6.0 mmol/L, postprandial glucoses < 8.0 mmol/L).Exclusion criteria: Pregestational diabetes mellitus, triplet/higher order multiple birth or stillbirth in the index pregnancy, requirement for interpreter.Trial entry and randomisation: Allocation to intervention will be undertaken using a telephone randomisation service (computer-generated random number sequence generation, with balanced variable blocks, and stratification by insulin requirement).Study groups: Women in the intervention group will receive a text reminder to attend for an oral glucose tolerance test at 6 weeks postpartum, with further reminders at 3 months and 6 months if they do not respond to indicate test completion. Women in the control group will receive a single text message reminder at 6 months postpartum.Blinding: Baseline data collection will be undertaken blinded. Blinding of participants and blinded collection of primary outcome data will not be possible for this study.Primary study outcome: Attendance for the oral glucose tolerance test within 6 months postpartum.Sample size: 276 subjects will be required to show an 18% absolute increase in the rate of attendance (α=0.05 two tailed, β=80%, 5% loss to follow up) from 37% to 55% in the intervention group.DiscussionGiven the heightened risk of impaired glucose tolerance and type 2 diabetes in women who have had gestational diabetes, ensuring the highest possible rate of attendance for postpartum glucose tolerance testing, so that early diagnosis and intervention can occur, is important. A text message reminder system may prove to be an effective method for achieving improved attendance for such testing. This randomised controlled trial will assess whether such a system will increase rates of attendance for postpartum oral glucose tolerance testing in women who have experienced gestational diabetes.Trial RegistrationAustralian New Zealand Clinical Trials Registry - ACTRN12612000621819

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.

258: Evaluation of the impact of an intensive follow-up program on postpartum glucose tolerance testing

Gestational diabetes mellitus (GDM) is a strong risk factor for developing overt diabetes later in life, and studies have demonstrated that identification of prediabetes can enable interventions preventing subsequent diabetes. Various professional societies have stressed the importance of postpartum glucose tolerance testing (GTT) for patients with GDM, although few strategies have been evaluated. We assessed the impact of a one-year program sponsored by the Rhode Island Department of Health aimed at increasing postpartum GTT using direct nurse and patient navigator supervision.

Physician care patterns and adherence to postpartum glucose testing after gestational diabetes mellitus in Oregon.

ObjectiveThis study examines obstetrician/gynecologists and family medicine physicians' reported care patterns, attitudes and beliefs and predictors of adherence to postpartum testing in women with a history of gestational diabetes mellitus.Research Design and MethodsIn November–December 2005, a mailed survey went to a random, cross-sectional sample of 683 Oregon licensed physicians in obstetrician/gynecologists and family medicine from a population of 2171.ResultsRoutine postpartum glucose tolerance testing by both family physicians (19.3%) and obstetrician/gynecologists physicians (35.3%) was reportedly low among the 285 respondents (42% response rate). Factors associated with high adherence to postpartum testing included physician stated priority (OR 4.39, 95% CI: 1.69–7.94) and physician beliefs about norms or typical testing practices (OR 3.66, 95% CI: 1.65–11.69). Specialty, sex of physician, years of practice, location, type of practice, other attitudes and beliefs were not associated with postpartum glucose tolerance testing.ConclusionsPostpartum glucose tolerance testing following a gestational diabetes mellitus pregnancy was not routinely practiced by responders to this survey. Our findings indicate that physician knowledge, attitudes and beliefs may in part explain suboptimal postpartum testing. Although guidelines for postpartum care are established, some physicians do not prioritize these guidelines in practice and do not believe postpartum testing is the norm among their peers.

Referral to Telephonic Nurse Management Improves Outcomes in Women With Gestational Diabetes

Objective We sought to determine whether, among women with gestational diabetes mellitus, referral to a telephonic nurse management program was associated with lower risk of macrosomia and increased postpartum glucose testing. Study Design There was medical center–level variation in the percent of patients referred to a telephonic nurse management program at 12 Kaiser Permanente medical centers, allowing us to examine in a quasi-experimental design the associations between referral and outcomes. Results Compared with women from centers where the annual proportion of referral nurse management was 70% were less likely to have a macrosomic infant and more likely to have postpartum glucose testing (multiple-adjusted odds ratio, 0.75; 95% confidence interval, 0.57–0.98 and multiple-adjusted odds ratio, 22.96; 95% confidence interval, 2.56–3.42, respectively). Conclusion Receiving care at the centers with higher referral frequency to telephonic nurse management for gestational diabetes mellitus was associated with decreased risk of macrosomic infant and increased postpartum glucose testing.

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.

Postpartum diet quality in Australian women following a gestational diabetes pregnancy

To describe the diet quality of a national sample of Australian women with a recent history of gestational diabetes mellitus (GDM) and determine factors associated with adherence to national dietary recommendations. A postpartum lifestyle survey with 1499 Australian women diagnosed with GDM ≤3 years previously. Diet quality was measured using the Australian recommended food score (ARFS) and weighted by demographic and diabetes management characteristics. Multinominal logistic regression analysis was used to determine the association between diet quality and demographic characteristics, health seeking behaviours and diabetes-related risk factors. Mean (±s.d.) ARFS was 30.9±8.1 from a possible maximum score of 74. Subscale component scores demonstrated that the nuts/legumes, grains and fruits were the most poorly scored. Factors associated with being in the highest compared with the lowest ARFS quintile included age (odds ratio (OR) 5-year increase=1.40; 95% (confidence interval) CI:1.16-1.68), tertiary education (OR=2.19; 95% CI:1.52-3.17), speaking only English (OR=1.92; 95% CI:1.19-3.08), being sufficiently physically active (OR=2.11; 95% CI:1.46-3.05), returning for postpartum blood glucose testing (OR=1.75; 95% CI:1.23-2.50) and receiving risk reduction advice from a health professional (OR=1.80; 95% CI:1.24-2.60). Despite an increased risk of type 2 diabetes, women in this study had an overall poor diet quality as measured by the ARFS. Women with GDM should be targeted for interventions aimed at achieving a postpartum diet consistent with the guidelines for chronic disease prevention. Encouraging women to return for follow-up and providing risk reduction advice may be positive initial steps to improve diet quality, but additional strategies need to be identified.

Dépistage du diabète de type 2 après un diabète gestationnel : rôle du médecin traitant

Following pregnancies with gestational diabetes mellitus (GDM), to assess: the perception by women of the risk of subsequent type 2 diabetes, the rate of screening for diabetes in the postpartum, and identify the factors leading women to undergo screening, in particular with respect to the information given to the general practitioner (GP) by the obstetrical team. A cohort study of all women with GDM who delivered in a single academic hospital between 1st June 2008 and 31st May 2009, based on data extracted from files and from phone interviews made 6 to 12 months after the delivery. Out of 152 GDM cases, 147 medical files were consulted and 124 phone interviews were performed. Fifty-one percent of the interviewed women were aware of the risk of type 2 diabetes. Eighty patients (65%) underwent postpartum glucose testing, out of which 69 were prescribed by the maternity and 27 women (22%) did not get any prescription. The compliance rate was 78% (53/69) for the hospital prescriptions and 100% (18/18) for the GP's prescriptions, a significant difference in uptake (P<0.05). Although it appears that the information given to the GP is the only factor improving patient awareness about type 2 diabetes (P=0.01), as well as their compliance to postpartum glucose testing (P=0.02), only 41 reports (28%) were sent to the GP out of the 63 reports (43%) mentioning the GDM. Postpartum testing for type 2 diabetes following a GDM was not optimal in this study. In view of the key role played by the GP in the postpartum period, it appears that cooperation between maternity and GPs needs to be reinforced in order to maximise both proper screening and diabetes primary prevention following GDM.

Referral to telephonic nurse management improves outcomes in women with gestational diabetes

We sought to determine whether, among women with gestational diabetes mellitus, referral to a telephonic nurse management program was associated with lower risk of macrosomia and increased postpartum glucose testing. There was medical center-level variation in the percent of patients referred to a telephonic nurse management program at 12 Kaiser Permanente medical centers, allowing us to examine in a quasi-experimental design the associations between referral and outcomes. Compared with women from centers where the annual proportion of referral nurse management was <30%, women who delivered from centers with an annual referral proportion >70% were less likely to have a macrosomic infant and more likely to have postpartum glucose testing (multiple-adjusted odds ratio, 0.75; 95% confidence interval, 0.57-0.98 and multiple-adjusted odds ratio, 22.96; 95% confidence interval, 2.56-3.42, respectively). Receiving care at the centers with higher referral frequency to telephonic nurse management for gestational diabetes mellitus was associated with decreased risk of macrosomic infant and increased postpartum glucose testing.