Effects of Implementing a Routine Postpartum Fasting Blood Glucose on the Completion of the Gold Standard 2-Hour Oral Glucose Tolerance Test in Gestational Diabetics

Alissa K. Prior; Cara D. Dolin; Whitney Bender; Celeste P. Durnwald; Rebecca F. Hamm

doi:10.1055/a-2312-8740

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(16): 2284-2289
DOI: 10.1055/a-2312-8740

Original Article

Effects of Implementing a Routine Postpartum Fasting Blood Glucose on the Completion of the Gold Standard 2-Hour Oral Glucose Tolerance Test in Gestational Diabetics

Alissa K. Prior

¹Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania

,

Cara D. Dolin

¹Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania

,

Whitney Bender

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia

,

Celeste P. Durnwald

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

,

Rebecca F. Hamm

¹Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania

²Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

› Author Affiliations

Abstract

Objective Rates of completion of the gold standard 2-hour oral glucose tolerance test (OGTT) for impaired glucose intolerance postpartum in patients with gestational diabetes mellitus (GDM) are consistently less than 50%. Screening tests performed prior to hospital discharge, including fasting blood glucose (FBG) to detect persistent hyperglycemia, have been investigated. We lack evidence, however, on whether implementation of routine postpartum FBG impacts the likelihood of obtaining the routine 2-hour OGTT. We sought to retrospectively compare the rates of completion of the 2-hour OGTT pre- and postimplementation of a routine FBG screen.

Study Design We performed a single-center retrospective cohort study comparing the completion of the 2-hour OGTT pre- and postimplementation of a routine FBG screen. Our primary outcome was the completion of the postpartum OGTT. Bivariate analyses assessed associations between demographic and preinduction clinical characteristics by pre- and post-implementation groups, as well as OGTT completion. Multivariable logistic regression was used to control for possible confounders. A sensitivity analysis was performed to account for the overlap with the coronavirus disease 2019pandemic.

Results In total, 468 patients met the inclusion and exclusion criteria. In our post-intervention group, 64% of patients completed a postpartum FBG. For our primary outcome, completion of the 2-hour OGTT significantly decreased in our postintervention group from 37.1 to 25.9% (p = 0.009), adjusted odds ratio (aOR): 0.62, confidence interval (CI): 0.41–0.92. This difference was no longer statistically significant when excluding patients during the pandemic, from 40.3 to 33.1% (p = 0.228), aOR: 0.76, CI: 0.455–1.27.

Conclusion Implementation of a routine FBG was associated with a negative impact on patients completing a 2-hour OGTT. The difference was no longer significant when excluding patients who would have obtained the OGTT during the pandemic, which may have been due to the smaller cohort. Future work should investigate patient perceptions of the FBG and its impact on their decision-making around the OGTT.

Key Points

Screening for postpartum glucose intolerance is imperative for gestational diabetics.
A fasting blood glucose is recommended as a postpartum screen for hyperglycemia in GDM patients.
Implementation of an FBG was associated with a decrease in completion of the gold standard OGTT.

Keywords

COVID-19 - fasting blood glucose - gestational diabetes - implementation - oral glucose tolerance test - pandemic - postpartum screening

Full Text

References

References
1 Correa A, Bardenheier B, Elixhauser A, Geiss LS, Gregg E. Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993-2009. Matern Child Health J 2015; 19 (03) 635-642
2 Bardenheier BH, Elixhauser A, Imperatore G. et al. Variation in prevalence of gestational diabetes mellitus among hospital discharges for obstetric delivery across 23 states in the United States. Diabetes Care 2013; 36 (05) 1209-1214
3 Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 2002; 25 (10) 1862-1868
4 Kaaja RJ, Greer IA. Manifestations of chronic disease during pregnancy. JAMA 2005; 294 (21) 2751-2757
5 Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW. Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol 2006; 108 (06) 1456-1462
6 Ratner RE, Christophi CA, Metzger BE. et al; Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 2008; 93 (12) 4774-4779
7 Practice Bulletin No. Practice Bulletin No. 137: gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2 Pt 1): 406-416
8 Pastore I, Chiefari E, Vero R, Brunetti A. Postpartum glucose intolerance: an updated overview. Endocrine 2018; 59 (03) 481-494
9 Werner EF, Has P, Tarabulsi G, Lee J, Satin A. Early postpartum glucose testing in women with gestational diabetes mellitus. [published correction appears in Am J Perinatol. 2016 Dec;33(14):1433–1434] Am J Perinatol 2016; 33 (10) 966-971
10 Kim C, Tabaei BP, Burke R. et al. Missed opportunities for type 2 diabetes mellitus screening among women with a history of gestational diabetes mellitus. Am J Public Health 2006; 96 (09) 1643-1648
11 Middleton P, Crowther CA. Reminder systems for women with previous gestational diabetes mellitus to increase uptake of testing for type 2 diabetes or impaired glucose tolerance. Cochrane Database Syst Rev 2014; 3 (03) CD009578
12 Mendez-Figueroa H, Daley J, Breault P. et al. Impact of an intensive follow-up program on the postpartum glucose tolerance testing rate. Arch Gynecol Obstet 2014; 289 (06) 1177-1183
13 Carson MP, Frank MI, Keely E. Original research: postpartum testing rates among women with a history of gestational diabetes—systematic review. Prim Care Diabetes 2013; 7 (03) 177-186
14 Werner EF, Has P, Rouse D, Clark MA. Society for Maternal-Fetal Medicine (SMFM). Two-day postpartum compared with 4- to 12-week postpartum glucose tolerance testing for women with gestational diabetes. Am J Obstet Gynecol 2020; 223 (03) 439.e1-439.e7
15 Carter EB, Martin S, Temming LA, Colditz GA, Macones GA, Tuuli MG. Early versus 6-12 week postpartum glucose tolerance testing for women with gestational diabetes. J Perinatol 2018; 38 (02) 118-121
16 Wessels A, Coetzee A, Mason D, Hall D, van de Vyver M, Conradie M. Utility of in-hospital post-delivery fasting plasma glucose to predict postpartum glucose status in women with hyperglycaemia first detected in pregnancy: a prospective cohort study. PLoS One 2020; 15 (10) e0239720
17 Waters TP, Kim SY, Werner E. et al. Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes?. Am J Obstet Gynecol 2020; 222 (01) 73.e1-73.e11
18 Blumer I, Hadar E, Hadden DR. et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. [published correction appears in J Clin Endocrinol Metab. 2016 Jan;101(1):343] [published correction appears in J Clin Endocrinol Metab. 2022 Aug 18;107(9):e3972] J Clin Endocrinol Metab 2013; 98 (11) 4227-4249
19 Arias MP, Wang E, Leitner K. et al. The impact on postpartum care by telehealth: a retrospective cohort study. Am J Obstet Gynecol MFM 2022; 4 (03) 100611