Risk assessment model identified women with abnormal OGTTs after gestational diabetes

The amount of missed postpartum diabetes cases among women with gestational diabetes may decrease with the use of a risk assessment model based on available antenatal risk factors to target women for postpartum oral glucose tolerance tests.

According to background information in a study abstract, 30% of women with recent gestational diabetes are glucose intolerant after delivery, but the rate of postpartum OGTTs is low. Researchers developed and evaluated a risk assessment model among a cohort of 605 white women with gestational diabetes. They administered OGTTs to these women 13 weeks after delivery.

One hundred thirty-two women (21.8%) had an abnormal postpartum OGTT; this included 2.8% with impaired fasting glucose, 13.6% with impaired glucose tolerance and 5.5% with diabetes. The researchers reported that independent risk factors for an abnormal OGTT included BMI ≥30, gestational age younger than 24 weeks at diagnosis, one-hour antenatal value >200 mg/dL and insulin therapy use.

Researchers then assessed the prevalence of an abnormal OGTT based on the number of risk factors: 9.2% of those women without risk factors, 13.4% of those with one risk factor, 28.5% of those with two risk factors, 45.6% of those with three risk factors, and 68.4% of women with four risk factors had abnormal OGTTs.

Those women considered low risk, or having fewer than two risk factors (59.9%), had an 11.6% prevalence of an abnormal OGTT and an OR of 1.3. Those with two risk factors (intermediate risk) had a 28.5% prevalence of abnormal OGTT and an OR of 4. Those with more than two risk factors (high risk) had a 51.3% prevalence and an OR of 10.5. Nearly 90% (86.6%) of women with diabetes and 67% of all those with an abnormal OGTT fell into the intermediate or high-risk group.

Schaefer-Graf UM. Diabetes Care. 2009;32:1960-1964.