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Am J Perinatol 2017; 34(12): 1264-1270
DOI: 10.1055/s-0037-1606620
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Immediate Postpartum Glucose Tolerance Testing in Women with Gestational Diabetes: A Pilot Study

Cheryl Dinglas
1   Department of Obstetrics and Gynecology, NYU Winthrop Hospital, Mineola, New York
2   Department of Obstetrics and Gynecology, Stony Brook University Hospital, Stony Brook, New York
,
Jolene Muscat
1   Department of Obstetrics and Gynecology, NYU Winthrop Hospital, Mineola, New York
,
Hye Heo
1   Department of Obstetrics and Gynecology, NYU Winthrop Hospital, Mineola, New York
,
Shahidul Islam
3   Department of Biostatistics, NYU Winthrop Hospital, Mineola, New York
,
Anthony Vintzileos
1   Department of Obstetrics and Gynecology, NYU Winthrop Hospital, Mineola, New York
› Author Affiliations
Further Information

Publication History

20 June 2017

24 August 2017

Publication Date:
14 September 2017 (online)

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Abstract

Objective Due to poor adherence for glucose testing at 6- to 12-week postpartum among women with gestational diabetes, we sought to determine whether a 2-hour glucose tolerance test (GTT) during postpartum hospitalization is predictive of 6- to 12-week postpartum glucose testing.

Study Design An institutional review board–approved prospective cohort study was performed over 3 years. Patients underwent an inpatient fasting 75-g, 2-hour GTT on either postpartum days 2 through 4 and instructed to follow up in 6- to 12-weeks for postpartum glucose testing. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of the immediate GTT to predict abnormal 6- to 12-week postpartum glucose testing were determined.

Results Eighty women enrolled in the study completed the immediate GTT; of these, only 35 (44%) underwent 6- to 12-week postpartum glucose testing. The sensitivity, specificity, PPV, and NPV of the immediate GTT were 100, 42.8, 30.4, and 100%, respectively.

Conclusion More than 50% of our study patients did not undergo recommended postpartum glucose testing, coinciding with similar poor follow-up reported in the literature. With a high NPV and high sensitivity, a negative immediate GTT may obviate the need for the 6- to 12-week GTT, while a positive GTT may identify women who should follow up closely.

Keywords

gestational diabetes - glucose tolerance test - glucose intolerance - postpartum testing

Note

This article was presented as a poster at the 37th Annual Pregnancy Meeting of the Society for Maternal–Fetal Medicine from January 22 to 28, 2017 at Las Vegas, NV.


 

  • References

  • 1 Committee on Practice Bulletins–Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2, Pt 1): 406-416
    CrossrefPubMedGoogle Scholar
  • 2 DeSisto CL, Kim SY, Sharma AJ. Prevalence estimates of gestational diabetes mellitus in the United States, Pregnancy Risk Assessment Monitoring System (PRAMS), 2007-2010. Prev Chronic Dis 2014; 11: E104
    PubMedGoogle Scholar
  • 3 Ferrara A, Hedderson MM, Quesenberry CP, Selby JV. Prevalence of gestational diabetes mellitus detected by the national diabetes data group or the Carpenter and Coustan plasma glucose thresholds. Diabetes Care 2002; 25 (09) 1625-1630
    CrossrefPubMedGoogle Scholar
  • 4 Schwartz N, Nachum Z, Green MS. The prevalence of gestational diabetes mellitus recurrence–effect of ethnicity and parity: a metaanalysis. Am J Obstet Gynecol 2015; 213 (03) 310-317
    CrossrefPubMedGoogle Scholar
  • 5 Roeckner JT, Sanchez-Ramos L, Jijon-Knupp R, Kaunitz AM. Single abnormal value on 3-hour oral glucose tolerance test during pregnancy is associated with adverse maternal and neonatal outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol 2016; 215 (03) 287-297
    CrossrefPubMedGoogle Scholar
  • 6 Nahum Sacks K, Friger M, Shoham-Vardi I. , et al. Prenatal exposure to gestational diabetes mellitus as an independent risk factor for long-term neuropsychiatric morbidity of the offspring. Am J Obstet Gynecol 2016; 215: 380.e1-380.e7
    CrossrefPubMedGoogle Scholar
  • 7 Palatnik A, Mele L, Landon MB. , et al. Timing of treatment initiation for mild gestational diabetes mellitus and perinatal outcomes. Am J Obstet Gynecol 2015; 213 (04) 560.e1-560.e8
    CrossrefPubMedGoogle Scholar
  • 8 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373 (9677): 1773-1779
    CrossrefPubMedGoogle Scholar
  • 9 Kwak SH, Choi SH, Jung HS. , et al. Clinical and genetic risk factors for type 2 diabetes at early or late post partum after gestational diabetes mellitus. J Clin Endocrinol Metab 2013; 98 (04) E744-E752
    CrossrefPubMedGoogle Scholar
  • 10 Kjos SL, Buchanan TA, Greenspoon JS, Montoro M, Bernstein GS, Mestman JH. Gestational diabetes mellitus: the prevalence of glucose intolerance and diabetes mellitus in the first two months post partum. Am J Obstet Gynecol 1990; 163 (1, Pt 1): 93-98
    CrossrefPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 Catov JM, Margerison-Zilko C. Pregnancy as a window to future health: short-term costs and consequences. Am J Obstet Gynecol 2016; 215 (04) 406-407
    CrossrefPubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 American Diabetes Association. 13. Management of diabetes in pregnancy. Diabetes Care 2017; 40 (Suppl. 01) S114-S119
    CrossrefPubMedGoogle Scholar
  • 15 Ryan EA, O'Sullivan MJ, Skyler JS. Insulin action during pregnancy. Studies with the euglycemic clamp technique. Diabetes 1985; 34 (04) 380-389
    CrossrefPubMedGoogle Scholar
  • 16 Sivan E, Whittaker PG, Sinha D. , et al. Leptin in human pregnancy: the relationship with gestational hormones. Am J Obstet Gynecol 1998; 179 (05) 1128-1132
    CrossrefPubMedGoogle Scholar
  • 17 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
    CrossrefPubMedGoogle Scholar
  • 18 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
    CrossrefPubMedGoogle Scholar
  • 19 Kwong S, Mitchell RS, Senior PA, Chik CL. Postpartum diabetes screening: adherence rate and the performance of fasting plasma glucose versus oral glucose tolerance test. Diabetes Care 2009; 32 (12) 2242-2244
    CrossrefPubMedGoogle Scholar
  • 20 Clarke H, Graham ID, Karovitch A, Keely EJ. Do postnatal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus? A randomized controlled trial. Am J Obstet Gynecol 2009; 200 (06) 634.e1-634.e7
    CrossrefPubMedGoogle Scholar
  • 21 Cosson E, Bihan H, Vittaz L. , et al. Improving postpartum glucose screening after gestational diabetes mellitus: a cohort study to evaluate the multicentre IMPACT initiative. Diabet Med 2015; 32 (02) 189-197
    CrossrefPubMedGoogle Scholar
  • 22 Heatley E, Middleton P, Hague W, Crowther C. The DIAMIND study: postpartum SMS reminders to women who have had gestational diabetes mellitus to test for type 2 diabetes: a randomised controlled trial - study protocol. BMC Pregnancy Childbirth 2013; 13: 92
    CrossrefPubMedGoogle Scholar
  • 23 Werner EF, Has P, Tarabulsi G, Lee J, Satin A. Early postpartum glucose testing in women with gestational diabetes mellitus. Am J Perinatol 2016; 33 (10) 966-971
    Article in Thieme ConnectPubMedGoogle Scholar