Postpartum screening for diabetes after a gestational diabetes mellitus-affected pregnancy.
OBJECTIVE
To estimate trends in postpartum glucose testing in a cohort of women with gestational diabetes mellitus (GDM).


METHODS
A validated computerized algorithm using Kaiser Permanente Northwest automated data systems identified 36,251 live births or stillbirths from 1999 through 2006. The annual percentage of pregnancies complicated by gestational diabetes with clinician orders for and completion of a fasting plasma glucose (FPG) test within 3 months of delivery was calculated. Logistic regression with generalized estimating equations was used to test for statistically significant trends.


RESULTS
The percentages of pregnancies affected by GDM increased from 2.9% in 1999 to 3.6% in 2006 (P<.01). Clinician orders for postpartum tests increased from 15.9% in 1999 to 79.3% in 2004 (P<.01), and then remained stable through 2006. Completed FPG tests increased from 9.0% in 1999 to 57.8% in 2004 (P<.01), and then remained stable through 2006. No oral glucose tolerance tests were ordered. From 2004 to 2006, the practice site where women received care was the factor most strongly associated with the clinician order, but it was not predictive of test completion. Among women with clinician orders, those who were Asian or Hispanic or who attended the 6-week postpartum examination were more likely to complete the test than their counterparts.


CONCLUSIONS
Postpartum glucose testing in women with GDM-affected pregnancies increased over time. However, even in recent years, 42% of women with GDM-affected pregnancies failed to have a postpartum FPG test, and no test was ordered for 21% of GDM-affected pregnancies.
Dietz
Patricia M
PM
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. PDietz@cdc.gov
Vesco
Kimberly K
KK
Callaghan
William M
WM
Bachman
Donald J
DJ
Bruce
F Carol
FC
Berg
Cynthia J
CJ
England
Lucinda J
LJ
Hornbrook
Mark C
MC
D000328:Adult; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000453:epidemiology; D016640:Diabetes, Gestational; D005260:Female; D005951:Glucose Tolerance Test / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D016017:Odds Ratio; D049590:Postpartum Period; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy