Trends in Postpartum Diabetes Screening and Subsequent Diabetes and Impaired Fasting Glucose among Women with Histories of Gestational Diabetes Mellitus. A report from the Translating Research Into Action for Diabetes (TRIAD) Study

Abstract

Objectives: To examine trends in postpartum glucose screening for women with gestational diabetes (GDM), predictors of screening, trends in postpartum impaired fasting glucose (IFG) and diabetes (DM) and DM and pre-diabetes detected by postpartum fasting glucose (FPG) vs. a 75-gram OGTT.

Research Design and Methods: Cohort of 14,448 GDM pregnancies delivered between 1995 and 2006. Postpartum screening was defined as performance of either an FPG or OGTT at least 6 weeks after delivery and within 1 year of delivery.

Results: Between 1995 and 2006, the age- and race/ethnicity adjusted proportion of women who were screened postpartum rose from 20.7% (95% CI 17.8–23.5) to 53.8% (51.3–56.3). Older age, Asian or Hispanic race/ethnicity, higher education, earlier GDM diagnosis, use of DM medications during pregnancy, and more provider contacts after delivery were independent predictors of postpartum screening. Obesity and higher parity were independently associated with lower screening performance. Among women who had postpartum screening, the age and race/ethnicity adjusted proportion of IFG did not change over time [24.2 (20.0–27.8) in 1995–1997 to 24.3 (22.6–26.0) in 2004–2006], but the proportion of women with DM decreased from 6.1 (4.2–8.1) in 1995–1997 to 3.3 (2.6–4.0) in 2004–2006. Among women who received an OGTT in 2006, 38% of the 204 women with either DM or pre-diabetes were captured only by the 2-hour glucose measurements.

Conclusions: Postpartum screening has increased over the last decade, but it is still suboptimal. Compared with FPGs alone, the 2-hour values alone identify a higher proportion of women with DM or pre-diabetes amenable to intervention.