Barriers to Postpartum Follow-Up and Glucose Tolerance Testing in Women with Gestational Diabetes Mellitus

Objective This study aims to examine factors associated with postpartum follow-up and glucose tolerance testing (GTT) in women with gestational diabetes mellitus (GDM). Materials and Methods Case-control study of women with GDM at a single institution with available outpatient records (January 2008–February 2016). Women with pregestational diabetes mellitus were excluded. The postpartum follow-up, GTT completion, and the reason for GTT completion failure (provider vs. patient noncompliance) were assessed. Bivariable and multivariable analyses were performed to identify factors associated with postpartum follow-up and GTT completion. Results Of 683 women, 82.0% (n = 560) returned postpartum, and 49.8% (n = 279) of those completed GTT. Women with Medicaid and late presentation to care were less likely to return (adjusted odds ratio [aOR]: 0.3, 95% confidence interval [CI]: 0.2–0.6 and aOR: 0.4, 95% CI: 0.2–0.7), but if they did, both factors were associated with increased odds of GTT completion (aOR: 2.0, 95% CI: 1.3–2.9 and aOR: 3.5, 95% CI: 1.8–6.6). Patient and provider noncompliance contributed equally to GTT completion failure. Trainee involvement was associated with improved test completion (aOR: 4.6, 95% CI: 2.4–8.8). Conclusion The majority of women with GDM returned postpartum, but many did not receive recommended GTT. Public insurance and late presentation were associated with failure to return postpartum, but better GTT completion when a postpartum visit occurred. Trainee involvement was associated with improved adherence to screening guidelines.

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Retinol-binding protein 4 responses during an oral glucose tolerance testing in women with gestational diabetes mellitus

Clinica Chimica Acta ◽

10.1016/j.cca.2008.01.030 ◽

2008 ◽

Vol 391 (1-2) ◽

pp. 123-125 ◽

Cited By ~ 9

Author(s):

Sang-Hwan Kim ◽

Jee-Aee Im ◽

Hee-Jeong Choi

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Retinol Binding Protein ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Oral Glucose Tolerance Testing ◽

Retinol Binding Protein 4 ◽

Tolerance Testing

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Gestational diabetes mellitus in a multiethnic population in Spain: Incidence of and factors associated to impaired glucose tolerance one year after delivery

Endocrinología Diabetes y Nutrición (English ed ) ◽

10.1016/j.endien.2018.07.013 ◽

2019 ◽

Vol 66 (4) ◽

pp. 240-246

Author(s):

Montserrat Prados ◽

Juana A. Flores-Le Roux ◽

David Benaiges ◽

Gemma Llauradó ◽

Juan José Chillarón ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Impaired Glucose Tolerance ◽

Factors Associated ◽

Multiethnic Population ◽

One Year

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Oral Glucose Tolerance Testing Allows Better Prediction of Diabetes in Women with a History of Gestational Diabetes Mellitus

Diabetes & Metabolism Journal ◽

10.4093/dmj.2018.0086 ◽

2019 ◽

Vol 43 (3) ◽

pp. 342 ◽

Cited By ~ 3

Author(s):

Tae Jung Oh ◽

Yeong Gi Kim ◽

Sunyoung Kang ◽

Joon Ho Moon ◽

Soo Heon Kwak ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Oral Glucose ◽

Oral Glucose Tolerance ◽

Oral Glucose Tolerance Testing ◽

History Of ◽

Prediction Of Diabetes ◽

Tolerance Testing

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Abnormal glucose tolerance post-gestational diabetes mellitus as defined by the International Association of Diabetes and Pregnancy Study Groups criteria

Acta Endocrinologica ◽

10.1530/eje-15-1260 ◽

2016 ◽

Vol 175 (4) ◽

pp. 287-297 ◽

Cited By ~ 23

Author(s):

Eoin Noctor ◽

Catherine Crowe ◽

Louise A Carmody ◽

Jean A Saunders ◽

Breda Kirwan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Glucose Tolerance ◽

Gestational Diabetes Mellitus ◽

Cumulative Incidence ◽

International Association ◽

Study Groups ◽

Abnormal Glucose Tolerance ◽

Diabetes And Pregnancy

Objective An increase in gestational diabetes mellitus (GDM) prevalence has been demonstrated across many countries with adoption of the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria. Here, we determine the cumulative incidence of abnormal glucose tolerance among women with previous GDM, and identify clinical risk factors predicting this. Design Two hundred and seventy women with previous IADPSG-defined GDM were prospectively followed up for 5years (mean 2.6) post-index pregnancy, and compared with 388 women with normal glucose tolerance (NGT) in pregnancy. Methods Cumulative incidence of abnormal glucose tolerance (using American Diabetes Association criteria for impaired fasting glucose, impaired glucose tolerance and diabetes) was determined using the Kaplan–Meier method of survival analysis. Cox regression models were constructed to test for factors predicting abnormal glucose tolerance. Results Twenty-six percent of women with previous GDM had abnormal glucose tolerance vs 4% with NGT, with the log-rank test demonstrating significantly different survival curves (P<0.001). Women meeting IADPSG, but not the World Health Organization (WHO) 1999 criteria, had a lower cumulative incidence than women meeting both sets of criteria, both in the early post-partum period (4.2% vs 21.7%, P<0.001) and at longer-term follow-up (13.7% vs 32.6%, P<0.001). Predictive factors were glucose levels on the pregnancy oral glucose tolerance test, family history of diabetes, gestational week at testing, and BMI at follow-up. Conclusions The proportion of women developing abnormal glucose tolerance remains high among those with IADPSG-defined GDM. This demonstrates the need for continued close follow-up, although the optimal frequency and method needs further study.

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