Barriers to Postpartum Glucose Intolerance Screening in an Italian Population

Quaresima, Paola; Visconti, Federica; Chiefari, Eusebio; Puccio, Luigi; Foti, Daniela; Venturella, Roberta; Vero, Raffaella; Brunetti, Antonio; Carlo, Costantino Di

doi:10.3390/ijerph15122853

Cited by 13 publications

(9 citation statements)

References 37 publications

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“…It is noteworthy that many prominent barriers for non-compliance with follow-up OGTT could be overcome through appropriate educational sessions [ 21 , 22 ] and reminder/engagement systems [ 23 , 24 ]. In this respect, previous studies have documented that fasting BG and/or HbA1c are not sensitive enough to replace the OGTT in early postpartum [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study

et al. 2021

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Aims To assess the proportion of women with gestational diabetes (GDM) by performing postpartum Oral Glucose Tolerance Test (OGTT) and to identify GDM phenotypes at high-risk of postpartum dysglycemia (PPD). Methods Observational, retrospective, multicenter study involving consecutive GDM women. Recursive partitioning (RECPAM) analysis was used to identify distinct and homogeneous subgroups of women at different PPD risk. Results From a sample of 2,736 women, OGTT was performed in 941 (34.4%) women, of whom 217 (23.0%) developed PPD. Insulin-treated women having family history of diabetes represented the subgroup with the highest PPD risk (OR 5.57, 95% CI 3.60–8.63) compared to the reference class (women on diet with pre-pregnancy BMI < = 28.1 kg/m2). Insulin-treated women without family diabetes history and women on diet with pre-pregnancy BMI > 28.1 kg/m2 showed a two-fold PPD risk. Previous GDM and socioeconomic status represent additional predictors. Fasting more than post-prandial glycemia plays a predictive role, with values of 81–87 mg/dl (4.5–4.8 mmol/l) (lower than the current diagnostic GDM threshold) being associated with PPD risk. Conclusions Increasing compliance to postpartum OGTT to prevent/delay PPD is a priority. Easily available characteristics identify subgroups of women more likely to benefit from preventive strategies. Fasting BG values during pregnancy lower than those usually considered deserve attention.

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Section: Discussionmentioning

confidence: 99%

Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study

et al. 2021

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“…Although these are the only significant associations in the present study, a few other articles 14 17 23 24 25 26 also relate primiparity, advanced maternal age, history of GDM in previous pregnancies and family history of DM as factors that increase patient adherence to screening.…”

Section: Discussionmentioning

confidence: 57%

Prevalence of Screening for Diabetes Mellitus in Patients Previously Diagnosed with Gestational Diabetes: Factors Related to its Performance

Kindermann

Costa

Trapani

2022

Rev Bras Ginecol Obstet

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Objective To determine how many patients underwent screening for diabetes mellitus (DM) in the puerperium after a diagnosis of gestational DM (GDM) and which factors were related to its performance. Methods The present is a prospective cohort study with 175 women with a diagnosis of GDM. Sociodemographic and clinico-obstetric data were collected through a questionnaire and a screening test for DM was requested six weeks postpartum. After ten weeks, the researchers contacted the patients by telephone with questions about the performance of the screening. The categorical variables were expressed as absolute and relative frequencies. The measure of association was the relative risk with a 95% confidence interval (95%CI), and values of p ≤ 0.05 were considered statistically significant and tested through logistic regression. Results The survey was completed by 159 patients, 32 (20.1%) of whom underwent puerperal screening. The mean age of the sample was of 30.7 years, and most patients were white (57.9%), married (56.6%), and had had 8 or more years of schooling (72.3%). About 22.6% of the patients used medications to treat GDM, 30.8% had other comorbidities, and 76.7% attended the postnatal appointment. Attendance at the postpartum appointment, the use of medication, and the presence of comorbidities showed an association with the performance of the oral glucose tolerance test in the puerperium. Conclusion The prevalence of screening for DM six weeks postpartum is low in women previously diagnosed with GDM. Patients who attended the postpartum consultation, used medications to treat GDM, and had comorbidities were the most adherent to the puerperal screening. We need strategies to increase the rate of performance of this exam.

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“…In conclusion, in our cohort of women with past GDM, we found no significant evidence of a protective effect of lactation on the development of T2D or associated cardiometabolic risk markers 9–16 years after the index pregnancy when women were at mid-life. The high prevalence of T2D, prediabetes, and obesity in this cohort at mid-life highlights the importance of longitudinal preventive care and screening among women with past GDM, who frequently fail to receive post-partum glucose tolerance testing [ 37 ]. Further studies in diverse populations among women at mid-age are needed to understand associations of breastfeeding with T2D.…”

Section: Discussionmentioning

confidence: 99%

Cumulative Lactation and Clinical Metabolic Outcomes at Mid-Life among Women with a History of Gestational Diabetes

et al. 2022

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Lactation is associated with a lower risk of subsequent cardiometabolic disease among parous women; however, the underlying mechanisms are unknown. Further, the potential protective effects of lactation on cardiometabolic risk markers at mid-life among high-risk women with past gestational diabetes (GDM) are not established. Using data from the Diabetes & Women’s Health Study (2012–2014; n = 577), a longitudinal cohort of women with past GDM from the Danish National Birth Cohort (1996–2002), we assessed associations of cumulative lactation duration (none, < 6 months, 6–12 months, ≥ 12–24 months, and ≥ 24 months) with clinical metabolic outcomes (including type 2 diabetes [T2D], prediabetes, and obesity) and cardiometabolic biomarkers (including biomarkers of glucose/insulin metabolism, fasting lipids, inflammation, and anthropometrics) 9–16 years after enrollment when women were at mid-life. At follow-up, women were 43.9 years old (SD 4.6) with a BMI of 28.7 kg/m2 (IQR 24.6, 33.0); 28.6% of participants had T2D, 39.7% had prediabetes, and 41.2% had obesity. Relative risks (95% CI) of T2D for 0–6, 6–12, 12–24, and ≥ 24 months of cumulative lactation duration compared to none were 0.94 (0.62,1.44), 0.88 (0.59,1.32), 0.73 (0.46,1.17), and 0.71 (0.40,1.27), respectively. Cumulative lactation duration was not significantly associated with any other clinical outcome or continuous biomarker. In this high-risk cohort of middle-aged women with past GDM, T2D, prediabetes, and obesity were common at follow-up, but not associated with history of cumulative lactation duration 9–16 years after the index pregnancy. Further studies in diverse populations among women at mid-age are needed to understand associations of breastfeeding with T2D.

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Barriers to Postpartum Glucose Intolerance Screening in an Italian Population

Cited by 13 publications

References 37 publications

Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study

Screening of postpartum diabetes in women with gestational diabetes: high-risk subgroups and areas for improvements—the STRONG observational study

Prevalence of Screening for Diabetes Mellitus in Patients Previously Diagnosed with Gestational Diabetes: Factors Related to its Performance

Cumulative Lactation and Clinical Metabolic Outcomes at Mid-Life among Women with a History of Gestational Diabetes

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