Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes?

Details

• Alternative Title:
  Am J Obstet Gynecol
• Personal Author:
  Waters, Thaddeus P. ; Kim, Shin Y. ; Werner, Erika ; Dinglas, Cheryl ; Carter, Ebony B. ; Patel, Roshni ; Sharma, Andrea J. ; Catalano, Patrick
• Description:
  BACKGROUND:
  
  Less than one-half of women with gestational diabetes mellitus are screened for type 2 diabetes postpartum. Other approaches to postpartum screening need to be evaluated, including the role of screening during the delivery hospitalization.
  
  OBJECTIVE:
  
  To assess the performance of an oral glucose tolerance test administered during the delivery hospitalization compared with the oral glucose tolerance test administered at a 4- to 12-week postpartum visit.
  
  STUDY DESIGN:
  
  We conducted a combined analysis of patient-level data from 4 centers (6 clinical sites) assessing the utility of an immediate postpartum 75-g oral glucose tolerance test during the delivery hospitalization (PP1) for the diagnosis of type 2 diabetes compared with a routine 4- to 12-week postpartum oral glucose tolerance test (PP2). Eligible women underwent a 75-g oral glucose tolerance test at both PP1 and PP2. Sensitivity, specificity, and negative and positive predictive values of the PP1 test were estimated for diagnosis of type 2 diabetes, impaired fasting glucose, or impaired glucose tolerance.
  
  RESULTS:
  
  In total, 319 women completed a PP1 screening, with 152 (47.6%) lost to follow-up for the PP2 oral glucose tolerance test. None of the women with a normal PP1 oral glucose tolerance test (n=73) later tested as having type 2 diabetes at PP2. Overall, 12.6% of subjects (n=21) had a change from normal to impaired fasting glucose/impaired glucose tolerance or a change from impaired fasting glucose/impaired glucose tolerance to type 2 diabetes. The PP1 oral glucose tolerance test had 50% sensitivity (11.8–88.2), 95.7% specificity (91.3–98.2%) with a 98.1% (94.5–99.6%) negative predictive value and a 30% (95% confidence interval, 6.7–65.3) positive predictive value for type 2 diabetes vs normal/impaired fasting glucose/impaired glucose tolerance result. The negative predictive value of having type 2 diabetes at PP2 compared with a normal oral glucose tolerance test (excluding impaired fasting glucose/impaired glucose tolerance) at PP1 was 100% (95% confidence interval, 93.5–100) with a specificity of 96.5% (95% confidence interval, 87.9–99.6).
  
  CONCLUSION:
  
  A normal oral glucose tolerance test during the delivery hospitalization appears to exclude postpartum type 2 diabetes mellitus. However, the results of the immediate postpartum oral glucose tolerance test were mixed when including impaired fasting glucose or impaired glucose tolerance. As a majority of women do not return for postpartum diabetic screening, an oral glucose tolerance test during the delivery hospitalization may be of use in certain circumstances in which postpartum follow-up is challenging and resources could be focused on women with an abnormal screening immediately after the delivery hospitalization.
  
  
• Subjects:
  Adult Ambulatory Care Article Diabetes, Gestational Diabetes Mellitus Diabetes Mellitus, Type 2 Female Gestational Diabetes Glucose Intolerance Glucose Tolerance Test Hospitalization Humans Mass Screening Postnatal Care Postpartum Predictive Value Of Tests Pregnancy Screening Sensitivity And Specificity

  More +
• Source:
  Am J Obstet Gynecol. 222(1):73.e1-73.e11
• Pubmed ID:
  31351065
• Pubmed Central ID:
  PMC7206508
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHS/United States ; UL1 TR000439/TR/NCATS NIH HHS/United States ; UL1 TR002548/TR/NCATS NIH HHS/United States
• Volume:
  222
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9d15d81dfe281f4a0a15c0c94c54d1aee552ad58c22cb8c024d72b9418e4503e
• Download URL:
  https://stacks.cdc.gov/view/cdc/87777/cdc_87777_DS1.pdf
• File Type:
  [PDF - 331.10 KB ]