Improving postpartum glucose screening after gestational diabetes mellitus: a cohort study to evaluate the multicentre IMPACT initiative.
OBJECTIVE
To evaluate a mobilization campaign, the IMPACT initiative, which included multidisciplinary meetings, provision of information and a systematic prescription of an oral glucose tolerance test to improve the rate of glucose screening in women with gestational diabetes mellitus in the four largest maternity units in our area, starting in March 2011.


METHODS
We retrospectively compared the level of self-reported screening during the first 6 months postpartum of women who gave birth after having been diagnosed with gestational diabetes before (January 2009 to December 2010) and after the IMPACT campaign (April 2011 to February 2012).


RESULTS
We included 961 women (589 in the period before and 372 in the period after the campaign was initiated) with a mean ± SD age of 33.2 ± 5.3 years and BMI of 27.8 ± 5.3 kg/m². Multivariate analysis, stratified using a propensity score in order to limit bias caused by imbalance between both periods, showed that the postpartum screening rate was higher after the campaign began (48.9 vs 33.3%, odds ratio 1.7, 95% CI 1.1-2.5; P = 0.019) and higher in women who received insulin treatment during pregnancy (odds ratio 2.3, 95% CI 1.5-3.6; P < 0.001), consumed fruit and vegetables daily (odds ratio 1.6, 95% CI 1.1-2.4; P = 0.035) and did not smoke (smoking vs non-smoking: odds ratio 0.3, 95% CI 0.1-0.7; P = 0.01). There was no interaction between the campaign effect and these particular conditions. The proportion of oral glucose tolerance tests performed in women who underwent screening increased from 6.3 to 33.0%.


CONCLUSIONS
The IMPACT campaign increased postpartum screening, and the use the oral glucose tolerance test in particular. The effect of this initiative might be reinforced in women who are non-daily consumers of fruit and vegetables, smokers and those who do not receive insulin treatment during pregnancy.
AP-HP, Jean Verdier Hospital, Department of Endocrinology, Diabetology and Nutrition, Université Paris 13, Sorbonne Paris Cité, Bondy; Sorbonne Paris Cité, UMR U1153 Inserm / U1125 Inra / Cnam / Université Paris 13, Bobigny, France.
E
E
Cosson
H
H
Bihan
L
L
Vittaz
C
C
Khiter
L
L
Carbillon
F
F
Faghfouri
D
D
Leboeuf
H
H
Dauphin
A
A
Lepagnol
G
G
Reach
P
P
Valensi
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016640:Diabetes, Gestational / Q000188:drug therapy / Q000503:physiopathology*; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D010349:Patient Compliance; D010353:Patient Education as Topic; D049590:Postpartum Period; D011236:Prediabetic State / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D018881:Suburban Health; D055815:Young Adult
D007004:Hypoglycemic Agents; D007328:Insulin