Abstract
Objective Over 70% of women with gestational diabetes mellitus (GDM) will develop diabetes
mellitus (DM), but only 30% follow through with the recommended postpartum oral glucose
tolerance testing (OGTT). HbA1c is approved to diagnose DM, and combined with a fasting plasma glucose it can identify
93% of patients with dysglycemia. We tested the hypothesis that a single blood draw
to assess for dysglycemia at the postpartum visit could improve testing rates compared
with those required to obtain an OGTT at an outside laboratory.
Study Design Prospective cohort study of all women with GDM who delivered between July 2010 and
December 2011. When insurance status required testing at an outside laboratory an
OGTT was ordered, when insurance allowed testing at our center a random sugar and
HbA1c were drawn at the postpartum visit (SUGAR Protocol).
Results Of the 40 women, 36 attended a postpartum visit. In the SUGAR arm, 19 of 19 (100%)
were tested versus 9 of 17 (53%) in the OGTT arm; relative risk of testing was 1.9
(95% confidence interval, 1.2–3.0). 36% were glucose intolerant.
Conclusion This pilot study found that an in-office testing model doubled the rate of postpartum
testing in this clinic population, and was reasonably sensitive at detecting dysglycemia.
Keywords
gestational diabetes mellitus - glucose intolerance - postpartum testing - pregnancy