J Korean Med Sci.  2015 Dec;30(12):1841-1846. 10.3346/jkms.2015.30.12.1841.

Postpartum Glucose Testing Rates Following Gestational Diabetes Mellitus and Factors Affecting Testing Non-compliance from Four Tertiary Centers in Korea

• Cho GJ
• An JJ
• Choi SJ
• Oh SY
• Kwon HS
• Hong SC
• Kwon JY

• KMID: 2359970
• DOI: http://doi.org/10.3346/jkms.2015.30.12.1841

Abstract

The purpose of this study was to investigate postpartum glucose testing rates in patients with gestational diabetes mellitus (GDM) and to determine factors affecting testing non-compliance in the Korean population. This was a retrospective study of 1,686 patients with GDM from 4 tertiary centers in Korea and data were obtained from medical records. Postpartum glucose testing was conducted using a 2-hr 75-g oral glucose tolerance, fasting glucose, or hemoglobin A1C test. Test results were categorized as normal, prediabetic, and diabetic. The postpartum glucose testing rate was 44.9% (757/1,686 patients); and of 757 patients, 44.1% and 18.4% had pre-diabetes and diabetes, respectively. According to the multivariate analysis, patients with a high parity, larger weight gain during pregnancy, and referral from private clinics due to reasons other than GDM treatment were less likely to receive postpartum glucose testing. However, patients who had pharmacotherapy for GDM were more likely to be screened. In this study, 55.1% of patients with GDM failed to complete postpartum glucose testing. Considering the high prevalence of diabetes (18.4%) at postpartum, clinicians should emphasize the importance of postpartum diabetes screening to patients with factors affecting testing noncompliance.

Keyword

Diabetes, Gestational; Postpartum Glucose Screening; Referral

MeSH Terms

Blood Glucose/*metabolism
Diabetes, Gestational/*blood
Fasting
Female
*Glucose Tolerance Test
Hemoglobin A, Glycosylated/metabolism
Humans
Mass Screening/statistics & numerical data
Patient Compliance/statistics & numerical data
Postpartum Period/*blood
Pregnancy
Republic of Korea
Retrospective Studies
Tertiary Care Centers
Blood Glucose
Hemoglobin A, Glycosylated

Figure

• 

  Fig. 1 The rates of postpartum glucose screening among 4 centers.

Reference

1. Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care. 2007; 30:S141–S146.

2. Schmidt MI, Duncan BB, Reichelt AJ, Branchtein L, Matos MC, Costa e Forti A, Spichler ER, Pousada JM, Teixeira MM, Yamashita T, et al. Gestational diabetes mellitus diagnosed with a 2-h 75-g oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001; 24:1151–1155.

3. Murgia C, Berria R, Minerba L, Malloci B, Daniele C, Zedda P, Ciccotto MG, Sulis S, Murenu M, Tiddia F, et al. Gestational diabetes mellitus in Sardinia: results from an early, universal screening procedure. Diabetes Care. 2006; 29:1713–1714.

4. Albrecht SS, Kuklina EV, Bansil P, Jamieson DJ, Whiteman MK, Kourtis AP, Posner SF, Callaghan WM. Diabetes trends among delivery hospitalizations in the U.S., 1994-2004. Diabetes Care. 2010; 33:768–773.

5. 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; 103:526–533.

6. Jang HC, Cho YM, Park KS, Kim SY, Lee HK, Kim MY, Yang JH, Shin SM. Pregnancy outcome in Korean women with gestational diabetes mellitus diagnosed by the Carpenter-Coustan criteria. J Korean Diabetes Assoc. 2004; 28:122–130.

7. American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2004; 27:S88–S90.

8. Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol. 1998; 179:476–480.

9. Chen Y, Quick WW, Yang W, Zhang Y, Baldwin A, Moran J, Moore V, Sahai N, Dall TM. Cost of gestational diabetes mellitus in the United States in 2007. Popul Health Manag. 2009; 12:165–174.

10. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002; 25:1862–1868.

11. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344:1343–1350.

12. Saaristo T, Moilanen L, Korpi-Hyövälti E, Saltevo J, Niskanen L, Jokelainen J, Peltonen M, Oksa H, Tuomilehto J, Uusitupa M, et al. Lifestyle intervention for prevention of type 2 diabetes in primary health care: one-year follow-up of the Finnish National Diabetes Prevention Program (FIN-D2D). Diabetes Care. 2010; 33:2146–2151.

13. 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; 113:1419–1421.

14. Hunt KJ, Conway DL. Who returns for postpartum glucose screening following gestational diabetes mellitus? Am J Obstet Gynecol. 2008; 198:404.e1–404.e6.

15. 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; 181:610–614.

16. Lawrence JM, Black MH, Hsu JW, Chen W, Sacks DA. Prevalence and timing of postpartum glucose testing and sustained glucose dysregulation after gestational diabetes mellitus. Diabetes Care. 2010; 33:569–576.

17. Russell MA, Phipps MG, Olson CL, Welch HG, Carpenter MW. Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol. 2006; 108:1456–1462.

18. Almario CV, Ecker T, Moroz LA, Bucovetsky L, Berghella V, Baxter JK. Obstetricians seldom provide postpartum diabetes screening for women with gestational diabetes. Am J Obstet Gynecol. 2008; 198:528.e1–528.e5.

19. Kwong S, Mitchell RS, Senior PA, Chik CL. Postpartum diabetes screening: adherence rate and the performance of fasting plasma glucose versus oral glucose tolerance test. Diabetes Care. 2009; 32:2242–2244.

20. Greenberg LR, Moore TR, Murphy H. Gestational diabetes mellitus: antenatal variables as predictors of postpartum glucose intolerance. Obstet Gynecol. 1995; 86:97–101.

21. Savitz DA, Janevic TM, Engel SM, Kaufman JS, Herring AH. Ethnicity and gestational diabetes in New York City, 1995-2003. BJOG. 2008; 115:969–978.

22. Chu SY, Abe K, Hall LR, Kim SY, Njoroge T, Qin C. Gestational diabetes mellitus: all Asians are not alike. Prev Med. 2009; 49:265–268.

23. Dietz PM, Vesco KK, Callaghan WM, Bachman DJ, Bruce FC, Berg CJ, England LJ, Hornbrook MC. Postpartum screening for diabetes after a gestational diabetes mellitus-affected pregnancy. Obstet Gynecol. 2008; 112:868–874.

24. 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; 32:269–274.

25. American College of Obstetricians and Gynecologists Committee on Practice Bulletins--Obstetrics. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994). Gestational diabetes. Obstet Gynecol. 2001; 98:525–538.

26. American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011; 34:S11–S61.

27. Kitzmiller JL, Dang-Kilduff L, Taslimi MM. Gestational diabetes after delivery. Short-term management and long-term risks. Diabetes Care. 2007; 30:S225–S235.

28. Kim C, Tabaei BP, Burke R, McEwen LN, Lash RW, Johnson SL, Schwartz KL, Bernstein SJ, Herman WH. Missed opportunities for type 2 diabetes mellitus screening among women with a history of gestational diabetes mellitus. Am J Public Health. 2006; 96:1643–1648.

29. 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; 200:634.e1–634.e7.

30. Korpi-Hyövälti E, Laaksonen DE, Schwab U, Heinonen S, Niskanen L. How can we increase postpartum glucose screening in women at high risk for gestational diabetes mellitus? Int J Endocrinol. 2012; 2012:519267.

31. Antoline C, Kramer A, Roth M. Implementation and methodology of a multidisciplinary disease-state-management program for comprehensive diabetes care. Perm J. 2011; 15:43–48.

32. Berg M, Adlerberth A, Sultan B, Wennergren M, Wallin G. Early random capillary glucose level screening and multidisciplinary antenatal teamwork to improve outcome in gestational diabetes mellitus. Acta Obstet Gynecol Scand. 2007; 86:283–290.

33. Sempowski IP, Houlden RL. Managing diabetes during pregnancy. Guide for family physicians. Can Fam Physician. 2003; 49:761–767.

34. Jang HC, Yim CH, Han KO, Yoon HK, Han IK, Kim MY, Yang JH, Cho NH. Gestational diabetes mellitus in Korea: prevalence and prediction of glucose intolerance at early postpartum. Diabetes Res Clin Pract. 2003; 61:117–124.

35. McNeely MJ, Boyko EJ. Type 2 diabetes prevalence in Asian Americans: results of a national health survey. Diabetes Care. 2004; 27:66–69.

36. Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, Zimmet P, Son HY. Epidemic obesity and type 2 diabetes in Asia. Lancet. 2006; 368:1681–1688.