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Postpartum Testing to Detect Persistent Dysglycemia in Women With Gestational Diabetes Mellitus

Carson, Michael P., MD; Ananth, Cande V., PhD, MPH; Gyamfi-Bannerman, Cynthia, MD, MSc; Smulian, John, MD, MPH; Wapner, Ronald J., MD

doi: 10.1097/AOG.0000000000002687
Contents: Medical Complications of Pregnancy: Current Commentary

The rate of gestational diabetes has doubled, and identifying the 30% with persistent postpartum dysglycemia (prediabetes or diabetes mellitus) is important because low-cost interventions have been proven to prevent overt diabetes mellitus, improve health for women, and potentially decrease the risk for birth defects in future pregnancies. Consensus guidelines continue to recommend a 4- to 12-week postpartum 2-hour oral glucose tolerance test (OGTT) despite persistent reports that only 35% of women complete the test. Physician ordering rates can improve, but the largest barriers to postpartum testing are clearly patient-related. Initiatives to improve OGTT testing rates have been only moderately effective and required allocation of staff time, diverting resources from other clinical areas. Alternative testing models using single-draw tests that bypass patient barriers show promise for improving the diagnosis of postpregnancy dysglycemia. Specifically, evidence is emerging in the pregnant and nonpregnant populations that, compared with the OGTT, the single-draw hemoglobin A1C test may identify more patients with prediabetes, bypasses patient barriers to testing such as the need for fasting, and has less laboratory variation compared with the OGTT or fasting plasma glucose. The risk–benefit focus should shift from comparing individual test performance statistics presuming the OGTT to be the “gold standard” to data reporting the ability of a test to facilitate identification of patients. We review the evidence regarding postpregnancy testing and make recommendations for strategies to improve the identification of dysglycemia and postpregnancy health.

Obtaining postpartum hemoglobin A1C levels in women with gestational diabetes mellitus can bypass well-documented patient barriers associated with other tests for dysglycemia to improve postpregnancy testing and health.

Departments of Medicine and Obstetrics and Gynecology, Seton Hall Hackensack Meridian School of Medicine, South Orange, and Division of Research/Outcomes, Jersey Shore University Medical Center, Neptune, New Jersey; and the Department of Obstetrics & Gynecology and Division of Maternal Fetal Medicine, Columbia University Medical Center, New York, New York.

Corresponding author: Michael P. Carson, MD, Department of Medicine, Seton Hall Hackensack Meridian School of Medicine, Jersey Shore University Medical Center, Ackerman 3, 1945 Route 33, Neptune, NJ 07753; email: Michael.Carson@hackensackmeridian.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received December 1, 2017. Received in revised form February 28, 2018. Accepted March 23, 2018.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.