Rates of postpartum glucose testing after gestational diabetes mellitus

Abstract

Objective: To estimate rates of postpartum glucose tolerance testing in women diagnosed with gestational diabetes mellitus (GDM) and to assess factors associated with testing.

Methods: This was a retrospective cohort study of 344 women with GDM who received prenatal care in a maternal diabetes clinic during 2001-2004. Rates of postpartum glucose testing were estimated from hospital, clinic, and laboratory records. Demographic, clinical (obstetric history, antenatal, and delivery), and health care information was obtained from chart review.

Results: Less than one half (45%) of women with GDM in our cohort underwent postpartum glucose testing-more than one third (36%) of whom had persistent abnormal glucose tolerance. After adjusting for clinical and health care characteristics, there was no independent relationship between most demographic characteristics and postpartum testing. Nor was there an association between clinical characteristics and the likelihood of being tested. Postpartum testing was strongly associated only with attendance of the postpartum visit: 54% of women who attended the visit were tested compared with 17% of women who did not attend (adjusted relative risk 3.04, 95% confidence interval 1.75-5.34, P<.001).

Conclusion: Although persistent abnormal glucose tolerance was common in our cohort, less than half of the women were tested for it. Our data suggest that to increase rates of postpartum glucose testing, improved attendance at the postpartum visit with greater attention to testing and better continuity between antenatal and postpartum care are required.

Level of evidence: II-2.