Most women with a history of gestational diabetes mellitus are not receiving recommended glycemic screenings in their first postpartum year. And screening rates vary based on geography, race, and use of antiglycemic medication in pregnancy, according to the results of a study published in Obstetrics & Gynecology.
Currently, the American College of Obstetricians and Gynecologists recommends screening all women with gestational diabetes mellitus (GDM) at 6-12 weeks postpartum with either fasting plasma glucose (FPG) or a 75-g 2-hour oral glucose tolerance test (OGTT). A hemoglobin A1c (HBA1c) is not recommended in the early postpartum period.
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Dr. Emma Morton Eggleston of Harvard Pilgrim Health Care Institute in Boston and her colleagues performed a retrospective analysis of medical records from a large U.S. health plan database to determine the rates of glycemic screenings – 75-g OGTT, HBA1c only, FPG only, or HbA1c plus FPG – in women with a history of GDM who were enrolled in the health plan from 2000-2012.
Rates were also measured for specific geographic regions, races/ethnicities, and patient clinical characteristics, including comorbidity in or before pregnancy, a visit to a nutritionist or diabetes educator during pregnancy, a visit to an endocrinologist during pregnancy, and the use of any antiglycemic agent during pregnancy (Obstet Gynecol. 2016;128:159-67. doi: 10.1097/AOG.0000000000001467).
Of all 447,556 women continuously enrolled in the health plan for 1 year before and after delivery, 32,253 (7.2%) had a history of GDM. The majority of women (76.1%) did not receive any of the glycemic screening tests in their first postpartum year.
The rates of these recommended tests were found to be low in general, although improvements in rates were noted between 2001 and 2011 for all but FPG alone, which declined from 7% within 12 weeks postpartum to 2% (adjusted odds ratio, 0.2). Conversely, the rate of receiving a 75-g OGTT within 12 weeks postpartum increased from 3% to 8% (adjusted OR, 3.2).
Geography was a predictor of postpartum screening. Women who lived in the West were the most likely to receive any screening within 12 weeks (18%) and at 1 year (31%). Among those who were screened, women in the West were most likely to receive a 75-g OGTT within 12 weeks (36%), compared with women in the Northeast (19%) and South (18%).
Race also played a role. Black women were the least likely to receive a 75-g OGTT and the most likely to receive HbA1c alone, even though this group has the highest rates of conversion to type 2 diabetes.
The strongest predictor of screening was the use of antiglycemic medication during pregnancy, according to the study. Women on antiglycemic medication in pregnancy (21%) were twice as likely to receive any type of screening, compared with women who were not on medication. Women who saw a nutritionist or diabetes educator during pregnancy, as well as those who saw an endocrinologist, were also more likely to receive any type of glycemic screening.
“Whether at the level of health system or population, quality improvement efforts must identify effective means of postpartum screening that are feasible for both women and health care providers and based on risk factors rather than geography or disparities in care,” the researchers wrote.
The researchers received grant support from the National Institutes of Health and the Centers for Disease Control and Prevention. No potential conflicts of interest were reported.