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Current Diabetes Reports

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01-02-2017 | Diabetes and Pregnancy (MF Hivert, Section Editor)

Interventions to Improve Rate of Diabetes Testing Postpartum in Women With Gestational Diabetes Mellitus

Authors: Maureen S. Hamel, Erika F. Werner

Published in: Current Diabetes Reports | Issue 2/2017

Abstract

Purpose of Review

Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. In the USA, four million women are screened annually for GDM in pregnancy in part to improve pregnancy outcomes but also because diagnosis predicts a high risk of future type 2 diabetes mellitus (T2DM). Therefore, among women with GDM, postpartum care should be focused on T2DM prevention. This review describes the current literature aimed to increase postpartum diabetes testing among women with GDM.

Recent Findings

Data suggest that proactive patient contact via a health educator, a phone call, or even postal mail is associated with higher rates of postpartum diabetes testing. There may also be utility to changing the timing of postpartum diabetes testing.

Summary

Despite the widespread knowledge regarding the importance of postpartum testing for women with GDM, testing rates remain low. Alternative testing strategies and large randomized trials addressing postpartum testing are warranted.

Committee on practice bulletins-Obstetrics. ACOG Practice Bulletin No. 137: gestational diabetes mellitus. Obstet Gynecol. 2013;122:406–16. doi:10.1097/01.AOG.0000433006.09219.f1.CrossRef

Kim SY, Saraiva C, Curtis M, Wilson HG, Troyan J, Sharma AJ. Fractionof gestational diabetes mellitus attributable to overweight and obesity by race/ethnicity, California 2007–2009. Am J Public Health. 2013;103:e65–72. doi:10.2105/AJPH.2013.301469.CrossRefPubMedPubMedCentral

Kim SY, Sharma AJ, Sappenfield W, Wilson HG, Salihu HM. Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age-births. Obstet Gynecol. 2014;123:737–44. doi:10.1097/AOG.0000000000000177.CrossRefPubMedPubMedCentral

Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care. 2008;31:899–904. doi:10.2337/dc07-2345.CrossRefPubMed

Ferrara A, Kahn HS, Quesenberry CP, Riley C, Hedderson MM. An increase in the incidence of gestational diabetes mellitus: Northern California, 1991–2000. Obstet Gynecol. 2004;103:526–33.CrossRefPubMed

• Eggleston EM, LeCates RF, Zhang F, Wharam JF, Ross-Degnan D, Oken E. Variation in postpartum glycemic screening in women with a history of gestational diabetes mellitus. Obstet Gynecol. 2016;128:159–67. doi:10.1097/AOG.0000000000001467. This retrospective cohort study uses commercial insurance claims to analyze patterns of postpartum diabetes testing among women with GDM, determine geographic, racial or socioeconomic differences in rates of follow-up and also to identify predictors of postpartum testing.CrossRefPubMed

Hunt KJ, Conway DL. Who returns for postpartum glucose screening following gestational diabetes mellitus? Am J Obstet Gynecol. 2008;198:404e1–6. doi:10.1016/j.ajog.2007.09.015.CrossRef

Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25:1832–8.

Hunt KJ, Logan SL, Conway DL, Korte JE. Postpartum screening following GDM: how well are we doing? Curr Diab Rep. 2010;10:235–41. doi:10.1007/s11892-010-0110-x.CrossRefPubMed

10.

Dawson SI. Glucose tolerance in pregnancy and the long-term risk of cardiovascular disease. Diabetes Res Clin Pract. 2009;85:14–9. doi:10.1016/j.diabres.2009.04.007.CrossRefPubMed

11.

Committee on Obstetric Practice. ACOG Committee Opinion No. 435: postpartum screening for abnormal glucose tolerance in women who had gestational diabetes mellitus. Obstet Gynecol. 2009;113:1419–21. doi:10.1097/AOG.0b013e3181ac06b6.CrossRef

12.

Su X, Zhang Z, Qu X, Tian Y, Zhang G. Hemoglobin A1c for the diagnosis of postpartum abnormal glucose tolerance among women with gestational diabetes mellitus: diagnostic meta-analysis. PLoS One. 2014;9:e102144. doi:10.1371/journal.pone.0102144.CrossRefPubMedPubMedCentral

13.

Kim C, Herman WH, Cheung NW, Gunderson EP, Richardson C. Comparison of hemoglobin A1c with fasting plasma glucose and 2-h postchallenge glucose for risk stratification among women with recent gestational diabetes mellitus. Diabetes Care. 2011;34:1949–51. doi:10.2337/dc11-0269.CrossRefPubMedPubMedCentral

14.

Kjos SL, Peters RK, Xiang A, Henry OA, Montoro M, Buchanan TA. Predicting future diabetes in Latino women with gestational diabetes. Utility of early postpartum glucose tolerance testing. Diabetes. 1995;44:586–91.CrossRefPubMed

15.

Gobl CS, Bozkurt L, Prikoszovich T, Winzer C, Pacini G, Kautzky-Willer A. Early possible risk factors for overt diabetes after gestational diabetes mellitus. Obstet Gynecol. 2011;118:71–8. doi:10.1097/AOG.0b013e318220e18f.CrossRefPubMed

16.

Tura A, Grassi A, Winhofer Y, Guolo A, Pacini G, Mari A, et al. Progression to type 2 diabetes in women with former gestational diabetes: time trajectories of metablic parameters. PLoS One. 2012;7:e50419. doi:10.1371/journal.pone.0050419.CrossRefPubMedPubMedCentral

17.

Keenan PS. Smoking and weight change after new health diagnoses in older adults. Arch Intern Med. 2009;9:237–42. doi:10.1001/archinternmed.2008.557.CrossRef

18.

Werner EF, Pettker CM, Zuckerwise L, Reel M, Funai EF, Henderson J, et al. Screening for gestational diabetes mellitus: are the criteria proposed by the international association of the diabetes and pregnancy study groups cost-effective? Diabetes Care. 2012;35:529–35. doi:10.2337/dc11-1643.CrossRefPubMedPubMedCentral

19.

Hughes RC, Moore MP, Gullam JE, Mohammed K, Rowan J. An early pregnancy HbA1c > 5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care. 2014;37:2953–9. doi:10.2337/dc14-1312.CrossRefPubMed

20.

Look ARG, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170:1566–75. doi:10.1001/archinternmed.2010.334.

21.

Williamson DA, Rejeski J, Lang W, Van Dorsten B, Fabricatore AN, Toledo K, et al. Impact of a weight management program on health-related quality of life in overweight adults with type 2 diabetes. Arch Intern Med. 2009;169:163–71. doi:10.1001/archinternmed.2008.544.CrossRefPubMedPubMedCentral

22.

Shea AK, Shah BR, Clark HD, Malcom J, Walker M, Karovitch A, et al. The effectiveness of implementing a reminder system into routine clinical practice: does it increase postpartum screening in women with gestational diabetes. Chronic Dis Can. 2011;31:58–64.PubMed

23.

Ratner RE, Christophi CA, Metzger BE, Dabelea D, Bennett PH, Pi-Sunyer X, et al. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008;93:4774–9. doi:10.1210/jc.2008-0772.CrossRefPubMedPubMedCentral

24.

Retnakaran R, Qi Y, Sermer M, Connelly PW, Hanley AJ, Zinman B. Glucose intolerance in pregnancy and future risk of pre-diabetes or diabetes. Diabetes Care. 2008;31:2026–31. doi:10.2337/dc08-0972.CrossRefPubMedPubMedCentral

25.

Conway DL, Langer O. Effects of new criteria for type 2 diabetes on the rate of postpartum glucose intolerance in women with gestational diabetes. Am J Obstet Gynecol. 1999;181:610–4.CrossRefPubMed

26.

Pallardo F, Herranz L, Garcia-Ingelmo T, Grande C, Martin-Vaguero P, Janez M, et al. Early postpartum metabolic assessment in women with prior gestational diabetes. Diabetes Care. 1999;22:1053–8.CrossRefPubMed

27.

Peterson C, Grosse SD, Li R, Sharma AJ, Razzaghi H, Herman WH, et al. Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States. Am J Obstet Gynecol. 2015;212:74. e1-9.CrossRefPubMed

28.

Bennett WL, Chang HY, Levine DM, Wang L, Neale D, Werner EF, et al. Utilization of primary and obstetric care after medically complicated pregnancies: an analysis of medical claims data. J Gen Intern Med. 2014;29:636–45. doi:10.1007/s11606-013-2744-2.CrossRefPubMedPubMedCentral

29.

Blatt AJ, Nakamoto JM, Kaufman HW. Gaps in diabetes screening during pregnancy and postpartum. Obstet Gynecol. 2011;117:61–8. doi:10.1097/AOG.0b013e3181fe424b.CrossRefPubMed

30.

Hale NL, Probst JC, Liu J, Martin AB, Bennett KJ, Glover S. Postpartum screening for diabetes among Medicaid-eligible South Carolina women with gestational diabetes. Womens Health Issues. 2012;22:e163–9. doi:10.1016/j.whi.2011.08.003.CrossRefPubMed

31.

• McCloskey L, Bernstein J, Winter M, Iverson R, Lee-Parritz A. Follow-up of gestational diabetes mellitus in an urban safety net hospital: missed opportunities to launch preventive care for women. J Womens Health. 2014;23:327–34. doi:10.1089/jwh.2013.4628. This cross-sectional study uses clinical and administrative data to calculate postpartum diabetes testing rates in the first 3 months and the first 6 months postpartum among GDM patients cared for a single institution in a major US city and to identify predictors of postpartum testing.CrossRef

32.

Shah BR, Lipscombe LL, Feig DS, Lowe JM. Missed opportunities for type 2 diabetes testing following gestational diabetes: a population-based cohort study. BJOG. 2011;118:1484–90. doi:10.1111/j.1471-0528.2011.03083.x.CrossRefPubMed

33.

Buchanan TA, Xiang A, Kjos SL, Lee WP, Trigo E, Nader I, et al. Gestational diabetes: antepartum characteristics that predict postpartum glucose intolerance and type 2 diabetes in Latino women. Diabetes. 1998;47:1302–10.CrossRefPubMed

34.

Schaefer-Graf UM, Klavehn S, Hartmann R, Kleinwechter H, Demandt N, Sorger M, et al. How do we reduce the number of cases of missed postpartum diabetes in women with recent gestational diabetes mellitus? Diabetes Care. 2009;32:1960–4. doi:10.2337/dc09-0627.CrossRefPubMedPubMedCentral

35.

Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care. 2007;30:S251–60. doi:10.2337/dc07-s225.CrossRefPubMed

36.

Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339–48. doi:10.1056/NEJMoa0902430.CrossRefPubMedPubMedCentral

37.

Paez KA, Eggleston EM, Griffey SJ, Farrar B, Smith J, Thompson J, et al. Understanding why some women with a history of gestational diabetes do not get tested for diabetes. Womens Health Issues. 2014;24:e373–9. doi:10.1016/j.whi.2014.04.008.CrossRefPubMed

38.

• Bernstein JA, McCloskey L, Gebel CM, Iverson RE, Lee-Parritz. Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes. BMJ Open Diabetes Res Care. 2016;17:e000250. doi:10.1136/bmjdrc-2016-000250. This qualitative study describes patients’ and providers’ perceptions of the current barriers to postpartum diabetes testing among women with GDM and also identifies potential facilitators of postpartum diabetes testing.CrossRef

39.

Markus AR, Rosenbaum S. The role of Medicaid in promoting access to high-quality, high-value maternity care. Womens Health Issues. 2010;20:S67–78. doi:10.1016/j.whi.2009.11.012.CrossRefPubMed

40.

McWilliams JM. Health consequences of uninsurance among adults in the United States: recent evidence and implications. Millbank Q. 2009;87:443–94. doi:10.1111/j.1468-0009.2009.00564.x.CrossRef

41.

Ferrara A, Hedderson MM, Albright CL, Ehrlich SF, Quesenberry Jr CP, Peng T, et al. A pregnancy and postpartum lifestyle intervention in women with gestational diabetes mellitus reduces diabetes risk factors: a feasibility randomized control trial. Diabetes Care. 2011;34:1519–25. doi:10.2337/dc10-2221.CrossRefPubMedPubMedCentral

42.

Giang L, Gjelsvik A, Cain R, Paine V. Gestational diabetes in Rhode Island. RI Med J. 2013;96:45–8.

43.

Ko JY, Dietz PM, Conrey EJ, Rodgers LE, Shellhaas C, Farr SL, et al. Strategies associated with higher postpartum glucose tolerance screening rates for gestational diabetes mellitus patients. J Womens Health. 2013;22:681–6. doi:10.1089/jwh.2012.4092.CrossRef

44.

Metzger BE, Cho NH, Roston SM, Radvany R. Prepregnancy weight and antepartum insulin secretion predict glucose tolerance five years after gestational diabetes mellitus. Diabetes Care. 1993;16:1598–605.CrossRefPubMed

45.

Stasenko M, Liddell J, Cheng YW, Sparks TN, Killion M, Caughey AB. Patient counseling increases postpartum follow-up in women with gestational diabetes mellitus. Am J Obstet Gynecol. 2011;204:522–6. doi:10.1016/j.ajog.2011.01.057.CrossRefPubMedPubMedCentral

46.

Dietz PM, Vesco KK, Callaghan WM, Bachman DJ, Bruce FC, Berg CJ, et al. Postpartum screening for diabetes after a gestational diabetes mellitus-affected pregnancy. Obstet Gynecol. 2008;112:868–74. doi:10.1097/AOG.0b013e318184db63.CrossRefPubMed

47.

Vesco KK, Dietz PM, Bulkley J, Bruce FC, Callaghan WM, England L, et al. A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes. Am J Obstet Gynecol. 2012;207:283–6. doi:10.1016/j.ajog.2012.08.017.CrossRefPubMed

48.

Mendez-Figueroa H, Daley J, Breault P, Lopes VV, Paine V, Goldman D, et al. Impact of an intensive follow-up program on the postpartum glucose tolerance testing rate. Arch Gynecol Obstet. 2014;289:1177–83. doi:10.1007/s00404-014-3157-0.CrossRefPubMed

49.

• Huynh T, Ghaffari N, Bastek J, Durnwald C. Prenatal care in a specialized diabetes in pregnancy program improves compliance with postpartum testing in GDM women. J Matern Fetal Neonatal Med. 2016;29:1–5. This retrospective cohort study evaluates the impact of a specialized diabetes in pregnancy program on rates of postpartum diabetes testing among women with GDM in a single health system.CrossRef

50.

Clark HD, Graham ID, Karovitch A, Keely EJ. Do postal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus? A randomized controlled trial. Am J Obstet Gynecol. 2009;200:634e1–7. doi:10.1016/j.ajog.2009.01.003.CrossRef

51.

• Werner EF, Has P, Tarabulsi G, Lee J, Satin A. Early postpartum glucose testing in women with gestational diabetes mellitus. Am J Perinatol. 2016;33:966–71. doi:10.1055/s-0036-1583193. This prospective pilot study investigates the feasibility of performing an oral glucose tolerance test on postpartum day 2 among women with GDM and then compares these results to results from the same women during the recommended testing period. The goal is to determine if testing on postpartum day 2 is a potentially adequate alternative testing regimen that could improve postpartum diabetes testing rates.CrossRefPubMed

52.

Sivan E, Whittaker PG, Sinha D, Homko CJ, Lin M, Reece EA, et al. Leptin in human pregnancy: the relationship with gestational hormones. Am J Obstet Gynecol. 1998;179:1128–32.CrossRefPubMed

53.

Klopper A, Buchan P, Wilson G. The plasma half-life of placental hormones. Br J Obstet Gynaecol. 1978;85:738–47.CrossRefPubMed

54.

Su LL, Chong YS, Chan YH, Chan YS, Fok D, Tun KT, et al. Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomized controlled trial. BMJ. 2007;335:596.CrossRefPubMedPubMedCentral

55.

Winickoff JP, Healey EA, Regan S, Park ER, Cole C, Friebely J, et al. Using the postpartum hospital stay to address mothers’ and fathers’ smoking: the NEWS study. Pediatrics. 2010;125:518–25. doi:10.1542/peds.2009-0356.CrossRefPubMed

Title: Interventions to Improve Rate of Diabetes Testing Postpartum in Women With Gestational Diabetes Mellitus
Authors: Maureen S. Hamel
Erika F. Werner
Publication date: 01-02-2017
Publisher: Springer US
Published in: Current Diabetes Reports / Issue 2/2017
Print ISSN: 1534-4827
Electronic ISSN: 1539-0829
DOI: https://doi.org/10.1007/s11892-017-0835-x

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Recent Findings

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