Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: A report from the Translating Research Into Action for Diabetes (TRIAD) Study.
OBJECTIVE
The purpose of this study was to examine trends in postpartum glucose screening for women with gestational diabetes mellitus (GDM), predictors of screening, trends in postpartum impaired fasting glucose (IFG) and diabetes, and diabetes and pre-diabetes detected by postpartum fasting plasma glucose (FPG) versus a 75-g oral glucose tolerance test (OGTT).


METHODS
This was a cohort study of 14,448 GDM pregnancies delivered between 1995 and 2006. Postpartum screening was defined as performance of either an FPG or OGTT at least 6 weeks after delivery and within 1 year of delivery.


RESULTS
Between 1995 and 2006, the age- and race/ethnicity-adjusted proportion of women who were screened postpartum rose from 20.7% (95% CI 17.8-23.5) to 53.8% (51.3-56.3). Older age, Asian or Hispanic race/ethnicity, higher education, earlier GDM diagnosis, use of diabetes medications during pregnancy, and more provider contacts after delivery were independent predictors of postpartum screening. Obesity and higher parity were independently associated with lower screening performance. Among women who had postpartum screening, the age- and race/ethnicity-adjusted proportion of IFG did not change over time (24.2 [95% CI 20.0-27.8] in 1995-1997 to 24.3 [22.6-26.0] in 2004-2006), but the proportion of women with diabetes decreased from 6.1 (95% CI 4.2-8.1) in 1995-1997 to 3.3 (2.6-4.0) in 2004-2006. Among women who received an OGTT in 2006, 38% of the 204 women with either diabetes or pre-diabetes were identified only by the 2-h glucose measurements.


CONCLUSIONS
Postpartum screening has increased over the last decade, but it is still suboptimal. Compared with FPGs alone, the 2-h values identify a higher proportion of women with diabetes or pre-diabetes amenable to intervention.
Ferrara
Assiamira
A
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. assiamira.ferrara@kp.org
Peng
Tiffany
T
Kim
Catherine
C
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002140:California; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D016640:Diabetes, Gestational / Q000175:diagnosis*; D005215:Fasting; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000453:epidemiology*; D006123:Group Practice; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D049590:Postpartum Period / Q000502:physiology*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D044469:Racial Groups; D012042:Registries; D013997:Time Factors
D001786:Blood Glucose