Postpartum Diabetes Screening

Kwong, Sarah; Mitchell, Rebecca S.; Senior, Peter; Chik, Constance L.

doi:10.2337/dc09-0900

Cited by 77 publications

(77 citation statements)

References 14 publications

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“…The short-term follow-up rate found in this study (18.5% at 6 months) is comparable with those reported in Canada: 14.3-48%; 24,42 somewhat worse than the US: 38-54%; 22,25,26 and considerably worse than Australia: 70-73%. 29,43 The GDM Recall Register in Australia may explain this large discrepancy.…”

Section: Comparison With Existing Literaturesupporting

confidence: 78%

“…26 There are limited published data on the long-term follow-up of females who have had GDM. Rates of up to 35% have been reported in the US 24 and 39% in the UK, 33 but again only through self-reported survey responses. This is somewhat better than the annual long-term screening rates found here from patient records: around 20%.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…[19][20][21][22][23][24][25][26][27][28] However, in Australia, where there is a greater focus on postpartum screening, data indicate that levels are as high as 73%. 29 There is a paucity of data on long-term follow-up; a US study indicated that approximately 40% of females were not tested at all in a 5-year period postpartum.…”

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confidence: 99%

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

et al. 2013

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Section: Comparison With Existing Literaturesupporting

confidence: 78%

Section: Comparison With Existing Literaturementioning

confidence: 99%

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

et al. 2013

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“…The use of medication, either insulin (8)(9)(10)(11) or oral agents (8) for glycemic control during pregnancy, is associated with persistent hyperglycemia, whereas body mass index (BMI) (10), race (9,11) and other risk factors (1-h blood glucose in diagnostic OGTT (11), previous GDM (9), parity rates (10)) are described in other studies.…”

Section: Introductionmentioning

confidence: 99%

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

Weinert

Mastella

Oppermann

et al. 2014

Arq Bras Endocrinol Metab

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Objectives: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. Subjects and methods: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). Results: 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). Conclusions: 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. Resultados: Das 209 mulheres arroladas na gestação, 108 (51,7%) foram avaliadas após o parto: 14 com glicemia de jejum, 93 com o TOTG e uma com glicemia ao acaso. O retorno para reavaliação foi associado com menor paridade (2 vs. 3, p < 0,001) e com glicemia de 2-h mais elevada no TOTG diagnóstico (165 vs. 155 mg/dL, p = 0,034). Diabetes foi diagnosticado em quatro mulheres (3,7%) e pré-diabetes em 22 (20,4%). Análise multivariada evidenciou que a história familiar de diabetes (risco relativo -RR 2,41, p = 0,050), a glicemia de 2 horas no TOTG da gestação (RR 1,01, p = 0,045), o uso de insulina na gestação (RR 2,37, p = 0,014) e a taxa de cesariana (RR 2,61, p = 0,015) foram os fatores associados à persistência da hiperglicemia. Conclusões: O retorno para reavaliação foi baixo, embora as alterações glicêmicas tenham sido frequentes. Como não houve fatores que indiquem quais mulheres retornarão, estratégias para aumentar a adesão são necessárias, especialmente quando há história familiar ou o DMG foi mais grave. Arq Bras Endocrinol Metab. 2014;58(2):197-204 Descritores Diabetes gestacional; reavaliação pós-parto; DMG; diabetes tipo 2; teste oral de tolerância à glicose ¹ Programa de Pós-graduação em Endocrinologia, Universidade Federal do Rio Grande do Sul

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“…When compared to the OGTT, single glucose and haemoglobin A1c levels have consistently been shown to be insensitive screening tests for type 2 diabetes in the postpartum period. [25][26][27][28][29][30][31][32][33] Recently, Capula et al found that 32.3% of women with previous GDM completed an OGTT within 6 and 12 weeks postpartum. Prepartum counselling and a diagnosis of polycystic ovarian syndrome were the strongest predictors of adherence to completing a postpartum OGTT.…”

Section: Discussionmentioning

confidence: 99%

Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes

et al. 2014

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Background: Postpartum screening for diabetes in women with gestational diabetes (GDM) improves with use of reminder systems. Our primary objective was to identify predictors of diabetes screening in the first year after delivery. Methods: A retrospective study was performed of 556 women with GDM who received outpatient prenatal care between 2007 and 2009. A mailed reminder system was utilized at two sites. Rates of postpartum glucose testing at 6 and 12 months postpartum were measured. Results: Site of care and non-smoking status were identified as the only predictors of postpartum diabetes screening (p50.001 and p ¼ 0.02, respectively). Rates of OGTT completion at one year (38% vs. 19% p50.001) were higher in women who attended clinics with postpartum reminders. Conclusions: The site of diabetes care in pregnancy is a major predictor of adherence to diabetes screening postpartum. Health care delivery should be considered in the development of strategies to increase screening rates.

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Postpartum Diabetes Screening

Cited by 77 publications

References 14 publications

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

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

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

Clinical predictors for diabetes screening in the first year postpartum after gestational diabetes

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