Barriers to Postpartum Follow-Up and Glucose Tolerance Testing in Women with Gestational Diabetes Mellitus
02 July 2017
04 September 2017
11 October 2017 (eFirst)
Objective This study aims to examine factors associated with postpartum follow-up and glucose tolerance testing (GTT) in women with gestational diabetes mellitus (GDM).
Methods Case-control study of women with GDM at a single institution with available outpatient records (January 2008–February 2016). Women with pregestational diabetes mellitus were excluded. The postpartum follow-up, GTT completion, and the reason for GTT completion failure (provider vs. patient noncompliance) were assessed. Bivariable and multivariable analyses were performed to identify factors associated with postpartum follow-up and GTT completion.
Results Of 683 women, 82.0% (n = 560) returned postpartum, and 49.8% (n = 279) of those completed GTT. Women with Medicaid and late presentation to care were less likely to return (adjusted odds ratio [aOR]: 0.3, 95% confidence interval [CI]: 0.2–0.6 and aOR: 0.4, 95% CI: 0.2–0.7), but if they did, both factors were associated with increased odds of GTT completion (aOR: 2.0, 95% CI: 1.3–2.9 and aOR: 3.5, 95% CI: 1.8–6.6). Patient and provider noncompliance contributed equally to GTT completion failure. Trainee involvement was associated with improved test completion (aOR: 4.6, 95% CI: 2.4–8.8).
Conclusion The majority of women with GDM returned postpartum, but many did not receive recommended GTT. Public insurance and late presentation were associated with failure to return postpartum, but better GTT completion when a postpartum visit occurred. Trainee involvement was associated with improved adherence to screening guidelines.
A large proportion of women with gestational diabetes mellitus do not receive recommended postpartum care due to both patient and provider noncompliance.
This study was presented in the poster format at the 37th annual meeting of the Society for Maternal-Fetal Medicine; January 23–28, 2017; Las Vegas, NV.
Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422, via the Northwestern University Clinical and Translational Sciences Institute Enterprise Data Warehouse Pilot program. Additionally, Lynn M. Yee is supported by the NICHD K12 HD050121–11. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- 1 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 137: Gestational diabetes mellitus. Obstet Gynecol Obstet Gynecol 2013; 122 (2 Pt 1): 406-416
- 2 Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 2007; 30 (Suppl. 02) S141-S146
- 3 Boghossian NS, Yeung E, Albert PS. , et al. Changes in diabetes status between pregnancies and impact on subsequent newborn outcomes. Am J Obstet Gynecol 2014; 210 (05) 431.e1-431.e14
- 4 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373 (9677): 1773-1779
- 5 Xiang AH, Li BH, Black MH. , et al. Racial and ethnic disparities in diabetes risk after gestational diabetes mellitus. Diabetologia 2011; 54 (12) 3016-3021
- 6 Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW. Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol 2006; 108 (06) 1456-1462
- 7 Martinez NG, Niznik CM, Yee LM. Optimizing postpartum care for the patient with gestational diabetes mellitus. Am J Obstet Gynecol 2017; 217 (03) 314-321
- 8 Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth 2014; 14: 41-58
- 9 Dietz PM, Vesco KK, Callaghan WM. , et al. Postpartum screening for diabetes after a gestational diabetes mellitus-affected pregnancy. Obstet Gynecol 2008; 112 (04) 868-874
- 10 American College of Obstetricians and Gynecologists' Committee on Obstetric Practice; Association of Women's Health, Obstetric and Neonatal Nurses. Committee Opinion No. 666: Optimizing postpartum care. Obstet Gynecol 2016; 127 (06) e187-e192
- 11 Ferrara A, Peng T, Kim C. 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. Diabetes Care 2009; 32 (02) 269-274
- 12 Cho GJ, An J-J, Choi S-J. , et al. Postpartum glucose testing rates following gestational diabetes mellitus and factors affecting non-compliance from four tertiary centers in Korea. J Korean Med Sci 2015; 30 (12) 1841-1846
- 13 Zera CA, Bates DW, Stuebe AM, Ecker JL, Seely EW. Diabetes screening reminder for women with prior gestational diabetes: a randomized controlled trial. Obstet Gynecol 2015; 126 (01) 109-114
- 14 Rankin KM, Haider S, Caskey R, Chakraborty A, Roesch P, Handler A. Healthcare utilization in the postpartum period among Illinois women with Medicaid paid claims for delivery, 2009–2010. Matern Child Health J 2016; 20 (Suppl. 01) 144-153
- 15 Beischer NA, Wein P, Sheedy MT. A follow-up program for women with previous gestational diabetes mellitus. Med J Aust 1997; 166 (07) 353-357
- 16 Smirnakis KV, Chasan-Taber L, Wolf M, Markenson G, Ecker JL, Thadhani R. Postpartum diabetes screening in women with a history of gestational diabetes. Obstet Gynecol 2005; 106 (06) 1297-1303
- 17 Stuebe A, Ecker J, Bates DW, Zera C, Bentley-Lewis R, Seely E. Barriers to follow-up for women with a history of gestational diabetes. Am J Perinatol 2010; 27 (09) 705-710