Research
Obstetrics
Obstetricians seldom provide postpartum diabetes screening for women with gestational diabetes

https://doi.org/10.1016/j.ajog.2007.11.001Get rights and content

Objective

We aimed to determine whether obstetrician-gynecologists provided postpartum type 2 diabetes mellitus screening for women with a history of gestational diabetes.

Study Design

We identified women diagnosed with gestational diabetes, and then assessed whether obstetrician-gynecologists provided postpartum diabetes mellitus screening by ordering American Diabetes Association-recommended glucose tests or by referring women to primary care physicians for such testing.

Results

Of 2617 gravid women with a 1-hour glucose challenge test, 90 had gestational diabetes and postpartum follow-up. Only 20.0% (18/90) of women with a history of gestational diabetes had documented orders from obstetrician-gynecologists for American Diabetes Association-recommended postpartum diabetes mellitus screening tests. Even when we broadened our definition of “providing postpartum diabetes mellitus screening” to also include referrals to primary care physicians, only 33.3% (30/90) of women met such criteria.

Conclusion

Obstetrician-gynecologists at an academic medical center did not provide postpartum diabetes mellitus screening for 66.7% of women with a history of gestational diabetes.

Section snippets

Materials and Methods

To identify women with GDM, we obtained data from the Laboratory Corporation of America (Burlington, NC) and Quest Diagnostics (Lyndhurst, NJ), the 2 main laboratories servicing obstetric-gynecologic patients (> 90%) at Thomas Jefferson University Hospital. We first found those who had a 50-g, 1-hour glucose challenge test (GCT) between July 1, 2004, and June 30, 2006, as this is our routine screening test for GDM. Those women who subsequently had a 100-g, 3-hour oral glucose tolerance test

Results

Of 2617 gravid women with a GCT, 77 subsequently had a 3h-OGTT with 2 or more abnormal values according to Carpenter-Coustan criteria.7 We thus identified them as having a GDM diagnosis. Twenty-eight subjects who forewent the 3h-OGTT because of a GCT greater than 190 mg/dL were also identified as having GDM. Therefore, the prevalence of GDM in our study population was 4.0% (105/2617).

We confirmed GDM diagnosis through a retrospective chart review. We excluded those without an official diagnosis

Comment

By using our strict definition of “providing postpartum DM screening,” we found that only 20.0% of women with a history of GDM had a documented order from obstetrician-gynecologists for ADA-recommended postpartum DM screening tests. When we broadened our definition to also include referrals to primary care physicians, only 33.3% of women met such criteria.

With both the strict and broad definition, obstetrician-gynecologists at a high-risk pregnancy office (private MFM office) were more likely

Acknowledgments

We thank and acknowledge the support and guidance provided by Dr Louis Weinstein at the Jefferson Medical College of Thomas Jefferson University and Dr Erika Johnston-MacAnanny at the University of Connecticut Health Science Center.

References (19)

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Cite this article as: Almario CV, Ecker T, Moroz LA, et al. Obstetricians seldom provide postpartum diabetes screening for women with gestational diabetes. Am J Obstet Gynecol 2008;198:528.e1-528.e5.

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