An opportunity not to be missed--how do we improve postpartum screening rates for women with gestational diabetes?
The ability to detect postpartum dysglycaemia, intervene and prevent type 2 diabetes in this high-risk population may be the most compelling reason to diagnose gestational diabetes. However, most studies show that less than 50% of women receive any glucose screening in the postpartum period and are thus denied this opportunity. Although many have advocated for simpler testing, the 75-g oral glucose tolerance test remains the gold standard as fasting glucose level will miss 30-40% of cases of type 2 diabetes and will not detect isolated impaired glucose tolerance. Haemoglobin A(1c) as a screening test has not been adequately studied. To improve postpartum screening rates, we need to increase awareness of the very high risk of type 2 diabetes, improve communication between providers, reduce fragmentation of care and introduce system factors that facilitate screening adherence.
Departments of Medicine and Obstetrics/Gynecology, University of Ottawa, Ottawa, ON, Canada. ekeely@toh.on.ca
Erin
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Keely
D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000209:etiology; D016640:Diabetes, Gestational / Q000175:diagnosis*; D005260:Female; D005951:Glucose Tolerance Test / Q000379:methods* / Q000592:standards; D006801:Humans; D049590:Postpartum Period; D011247:Pregnancy