Postpartum Follow-up for Women with Gestational Diabetes Mellitus

ABSTRACT

We sought to determine the frequency of postpartum follow-up for women diagnosed with gestational diabetes mellitus. A retrospective cohort study of women with gestational diabetes mellitus from 2002 to 2008 (n = 745) at an academic center was conducted. The primary outcome was either fasting blood glucose or 2-hour oral glucose tolerance, both measured at ≤6 months postpartum. Chi-square test and multivariable logistic regression analysis were used for statistical comparisons, and statistical significance was indicated by p < 0.05 and 95% confidence intervals. The frequency of follow-up for the study cohort was 33.7%. Of these women, 28.3% had values consistent with impaired glucose tolerance and 2.0% were diagnosed with type 2 diabetes mellitus. Asian women were the most likely to follow up (43%), and Latinas had the lowest follow-up frequency (18%; p < 0.001). Compared with their counterparts, women ≥35 years old, nulliparas, and women with GDM subtype A2 were more likely to return for postpartum glucose testing (odds ratio [OR] = 1.7, 95% confidence interval [CI] 1.2 to 2.5; OR = 1.9, 95% CI 1.3 to 2.7; OR = 2.28, 95% CI 1.4 to 3.6, respectively). The frequency of postpartum follow-up for women diagnosed with gestational diabetes mellitus is exceedingly low. More effective strategies are needed to increase the postpartum and longitudinal follow-up for all women with gestational diabetes mellitus.

KEYWORDS

Gestational diabetes mellitus - postpartum screening - type 2 diabetes mellitus - follow-up predictors

REFERENCES

• 1 American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics . ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes.  Obstet Gynecol. 2001;  98 525-538
• 2 American Diabetes Association . Gestational diabetes mellitus.  Diabetes Care. 2004;  27(Suppl 1) S88-S90
• 3 Nesbitt T S, Gilbert W M, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California.  Am J Obstet Gynecol. 1998;  179 476-480
• 4 Kim C, Newton K M, Knopp R H. Gestational diabetes and the incidence of type 2 diabetes: a systematic review.  Diabetes Care. 2002;  25 1862-1868
• 5 Damm P, Kühl C, Bertelsen A, Mølsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus.  Am J Obstet Gynecol. 1992;  167 607-616
• 6 Lauenborg J, Hansen T, Jensen D M et al.. Increasing incidence of diabetes after gestational diabetes: a long-term follow-up in a Danish population.  Diabetes Care. 2004;  27 1194-1199
• 7 Russell M A, Phipps M G, Olson C L, Welch H G, Carpenter M W. Rates of postpartum glucose testing after gestational diabetes mellitus.  Obstet Gynecol. 2006;  108 1456-1462
• 8 Smirnakis K V, Chasan-Taber L, Wolf M, Markenson G, Ecker J L, Thadhani R. Postpartum diabetes screening in women with a history of gestational diabetes.  Obstet Gynecol. 2005;  106 1297-1303
• 9 Kim C, Tabaei B, Burke R et al.. Missed opportunities for diabetes screening among women with a history of gestational diabetes.  Am J Public Health. 2006;  96 1643-1648
• 10 Hunt K J, Conway D L. Who returns for postpartum glucose screening following gestation diabetes mellitus?.  Am J Obstet Gynecol. 2008;  198 404.e1-6
• 11 Li G, Zhang P, Wang J et al.. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study.  Lancet. 2008;  371 1783-1789