Abstract
Objective To identify barriers to postpartum glucose testing in women with a history of gestational
diabetes mellitus (GDM).
Materials and Methods This is a prospective cohort study of 300 women with GDM who completed questionnaires
on socioeconomic barriers and validated instruments to measure trust in their clinician
and health agency. At 12 weeks' postpartum, women were recontacted and postpartum
records were collected. Women who completed glucose testing between 4 and 12 weeks'
postpartum were compared with women who did not with regard to modifiable and nonmodifiable
barriers to care.
Results Of the 373 women approached, 300 (80%) consented to participate, completed surveys
on postpartum day 2, and had records retrieved at 12 weeks' postpartum. Validated
instruments used showed internal consistency (Cronbach's α > 0.6). Only 126 (42%) of the participants completed postpartum glucose testing,
and these women were more likely to have reliable transportation, private insurance,
college degrees, and higher annual household incomes (p < 0.05). Postpartum glucose testing was also associated with trust in clinicians
(p = 0.01) but not health agency (p = 0.66). The association between trust and postpartum glucose testing persisted after
adjusting for nonmodifiable barriers.
Conclusion Maximizing trust in clinicians should be a focus of prenatal GDM care to maximize
the likelihood of postpartum glucose testing.
Keywords
gestational diabetes - postpartum - glucose tolerance test - diabetes - prediabetes
