TRIAD: Postpartum diabetes screening increased, but rate is still suboptimal

OGTT was a better predictor of women with diabetes or prediabetes than FPG.

The number of women with history of gestational diabetes screened for postpartum diabetes increased from 20.7% in 1995 to 53.8% in 2006, according to the results of a new report from the TRIAD study. However, the proportion of women screened for postpartum diabetes after delivery remains suboptimal, according to the researchers.

Researchers with the TRIAD study examined trends and predictors of postpartum glucose screening and the proportion of diabetes and prediabetes among women with gestational diabetes. They analyzed 14,448 gestational diabetes pregnancies delivered between 1995 and 2006. Postpartum screening was defined as performance of either fasting plasma glucose or 75-g oral glucose tolerance test six weeks after delivery up to one year after delivery.

“Performance of a fasting plasma glucose alone, as opposed to the OGTT, will miss a subpopulation of women at risk,” the researchers wrote in Diabetes Care. “Interventions that increase postpartum screening performance are needed.”

TRIAD results

Postpartum screening was more common in women with a history of gestational diabetes who were older, had a higher education level and earlier gestational diabetes diagnosed, used diabetes medications during pregnancy and maintained more provider contacts after delivery. Further, the researchers reported a marked increase in the proportion of Hispanic women with gestational diabetes who were screened between 1995 (14.1%) and 2006 (24.9%). Obesity and higher parity were independently associated with lower screening performance.

Women who had postpartum screening did not experience a change in the age- and race/ethnicity-adjusted proportion of impaired fasting glucose in 1995 to 1997 (24.2%) or 2004 to 2006 (24.3%). However, the proportion of women with a positive postpartum screen for diabetes decreased from 6.1% in 1995 to 1997 to 3.3% in 2004 to 2006, according to the study.

“This observed decrease in diabetes among women with postpartum screening is not likely to be a consequence of the small increase (3%) in gestational diabetes screening over time … more likely because of better identification of diabetes before pregnancy, as suggested by the reported increase in postpartum screening among women with gestational diabetes and because of an increase in glucose screening in postpartum women without gestational diabetes,” the researchers wrote.

The researchers observed an increasing trend in the proportion of women who were screened with OGTT, from 5% in 1996 to 16.6% in 2005 to 71.5% in 2006. A total of 600 women underwent OGTT in 2006, 16 of whom had diabetes at postpartum based on OGTT measurement compared with four women based on fasting plasma glucose alone. Thirty-eight percent of the 204 women with either diabetes or prediabetes were identified only by the two-hour glucose measurements, according to the study.

Diabetes Care. 2009;32:269-274.