Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes?
Open accessAbstract
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.
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OGTT testing immediately postpartum, while still hospitalized, has demonstrated improved engagement in testing but also variably reduced sensitivity to the diagnosis of impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes.
“OGTT testing immediately postpartum, while still hospitalized, has demonstrated improved engagement in testing but also variably reduced sensitivity to the diagnosis of impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes (131,132).”
From 15. Management of Diabetes in Pregnancy: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [131]
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15. Management of Diabetes in Pregnancy: <i>Standards of Care in Diabetes—2024</i>
American Diabetes Association Professional Practice Committee, ElSayed, N. A., Aleppo, G., Bannuru, R. R., Bruemmer, D., Collins, B. S., Ekhlaspour, L., Hilliard, M. E., Johnson, E. L., Khunti, K., et al. (2024) · Diabetes Care · doi:10.2337/dc24-s015 · Cited by 232 · see citing works
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- Authors
- Waters, T. P., Kim, S. Y., Werner, E., Dinglas, C., Carter, E. B., Patel, R., Sharma, A. J., & Catalano, P.
- Affiliations
- Loyola University Medical Center (US)
- Centers for Disease Control and Prevention (US)
- Brown University (US)
- Winthrop-University Hospital (US)
- Washington University in St. Louis (US)
- MetroHealth Medical Center (US)
- Corresponding author
- Waters, Thaddeus P.
- ORCID
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 222
- Issue
- 1
- Pages
- 73.e1-73.e11
- ISSN
- 0002-9378 (ISSN-L)
- PMC
- PMC7206508
- OpenAlex
- W2963115159
- Cited by
- 44
- References
- 25
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 10 · 2023: 4 · 2022: 5 · 2021: 3 · 2020: 7
- FWCI
- 4.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Clinical and Translational Science Collaborative of Cleveland, School of Medicine, Case Western Reserve University
- American Diabetes Association
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- gestational diabetes mellitus, type 2 diabetes screening, postpartum screening, oral glucose tolerance test, delivery hospitalizations, impaired fasting glucose, impaired glucose tolerance, diagnostic accuracy, sensitivity and specificity, predictive value, loss to follow-up, cost-effectiveness of screening
- MeSH terms
- Adult, Ambulatory Care, Diabetes Mellitus, Type 2, Female, Glucose Tolerance Test, Hospitalization, Humans, Mass Screening, Postnatal Care, Predictive Value of Tests, Pregnancy, Sensitivity and Specificity, Diabetes, Gestational, Glucose Intolerance
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