Two-day postpartum compared with 4- to 12-week postpartum glucose tolerance testing for women with gestational diabetes
Abstract
Background A majority of women in the United States with gestational diabetes mellitus do not undergo the recommended 4- to 12-week postpartum glucose tolerance test.Objective This study aimed to compare the diagnostic value of the 2-day postpartum glucose tolerance test with the 4- to 12-week postpartum glucose tolerance test to identify impaired glucose metabolism at 1 year after delivery among women with gestational diabetes.Study design Postpartum women who delivered at 1 hospital between January 2017 and July 2018 were offered enrollment in a prospective cohort if they had gestational diabetes mellitus diagnosed by Carpenter-Coustan criteria or a 1-hour glucose challenge test result of ≥200 mg/dL, spoke English or Spanish, and planned to remain in the hospital for at least 2 days after delivery. Participating women underwent a 75-gram 2-hour glucose tolerance test on postpartum day 2 and were incentivized to have a 4- to 12-week glucose tolerance test and measurement of glycosylated hemoglobin at 1 year after delivery. Participants and providers were blinded to the 2-day postpartum results. The diagnostic value of an abnormal 2-day postpartum glucose tolerance test (fasting result of ≥100 mg/dL or 2-hour glucose tolerance test result of ≥140 mg/dL) was compared with that of an abnormal 4- to 12-week glucose tolerance test to identify impaired glucose metabolism (≥5.7% glycosylated hemoglobin) and diabetes (≥6.5% glycosylated hemoglobin) at 1 year after delivery. Receiver operating characteristic (ROC) curves were also compared at 2 days and 4-12 weeks after delivery.Results Of the 300 recruited women, 296 (99%) completed the 2-day postpartum glucose tolerance test, and 202 (68%) returned for the 4- to 12-week glucose tolerance test. Approximately 1 year after delivery, 203 (68%) women had their glycosylated hemoglobin measured, of whom 35% had impaired glucose metabolism and 4% had diabetes. The study population was diverse (46% nonwhite). Furthermore, 56% were obese (mean body mass index, 32 kg/m 2), and 55% had received medication to control their glucose during pregnancy. There were no significant differences between the 2-day and 4- to 12-week postpartum glucose tolerance tests in predicting impaired glucose metabolism based on ≥5.7% glycosylated hemoglobin in 1 year after delivery: sensitivity (46% vs 36%); specificity (79% vs 84%); positive predictive value (52% vs 53%); and negative predictive value (75% vs 72%). There was also no difference between the 2-day and the 4- to 12-week glucose tolerance tests in identifying diabetes at 1 year after delivery. Both the 2-day and 4- to 12-week glucose tolerance tests had similar ROC curves in identifying impaired glucose metabolism and diabetes at 1 year after delivery.Conclusion Two-day postpartum glucose tolerance tests have similar diagnostic value as 4- to 12-week postpartum glucose tolerance tests in predicting impaired glucose metabolism and diabetes at 1 year after delivery and are associated with nearly 100% adherence to the test. Thus, changing the timing of the glucose tolerance test should be considered.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [132]
Cites
1 retracted
(2009) · Obstetrics and Gynecology · doi:10.1097/aog.0b013e3181ac06b6 · Cited by 79 · see citing works
RetractedACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus
(2018) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000002501 · Cited by 1,820 · see citing works
Ratner, R. E., Christophi, C. A., Metzger, B. E., Dabelea, D., Bennett, P. H., Pi-Sunyer, X., Fowler, S., Kahn, S. E., & The Diabetes Prevention Program Research Group (2008) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-0772 · Cited by 867 · see citing works
15. Management of Diabetes in Pregnancy: <i>Standards of Medical Care in Diabetes—2022</i>
American Diabetes Association Professional Practice Committee (2022) · Diabetes Care · doi:10.2337/dc22-s015 · Cited by 504 · see citing works
Aroda, V. R., Christophi, C. A., Edelstein, S. L., Zhang, P., Herman, W. H., Barrett-Connor, E., Delahanty, L. M., Montez, M. G., Ackermann, R. T., Zhuo, X., et al. (2015) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-3761 · Cited by 467 · see citing works
Bennett, W. L., Chang, H.-Y., Levine, D. M., Wang, L., Neale, D., Werner, E. F., & Clark, J. M. (2014) · Journal of General Internal Medicine · doi:10.1007/s11606-013-2744-2 · Cited by 214 · see citing works
Self-citationWerner, E. F., Pettker, C. M., Zuckerwise, L., Reel, M., Funai, E. F., Henderson, J., & Thung, S. F. (2012) · Diabetes Care · doi:10.2337/dc11-1643 · Cited by 182 · see citing works
Self-citationBennett, W. L., Ennen, C. S., Carrese, J. A., Hill‐Briggs, F., Levine, D. M., Nicholson, W. K., & Clark, J. M. (2011) · Journal of Women s Health · doi:10.1089/jwh.2010.2233 · Cited by 175 · see citing works
Postpartum Diabetes Screening in Women With a History of Gestational Diabetes
Smirnakis, K. V., Chasan‐Taber, L., Wolf, M. S., Markenson, G. R., Ecker, J. L., & Thadhani, R. (2005) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000189081.46925.90 · Cited by 146 · see citing works
Ryswyk, E. V., Middleton, P., Hague, W. M., et al. (2014) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2014.09.001 · Cited by 49 · see citing works
Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes?
Waters, T. P., Kim, S. Y., Werner, E., Dinglas, C., Carter, E. B., Patel, R., Sharma, A. J., & Catalano, P. (2020) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2019.07.035 · Cited by 44 · see citing works
Self-citationHale, N. L., Probst, J. C., Liu, J., Martin, A. B., Bennett, K. J., & Glover, S. H. (2011) · Women s Health Issues · doi:10.1016/j.whi.2011.08.003 · Cited by 39 · see citing works
Early Postpartum Glucose Testing in Women with Gestational Diabetes Mellitus
Has, P., Tarabulsi, G., Lee, J., Satin, A. J., & Werner, E. F. (2016) · American Journal of Perinatology · doi:10.1055/s-0036-1583193 · Cited by 37 · see citing works
Self-citationEarly versus 6–12 week postpartum glucose tolerance testing for women with gestational diabetes
Carter, E. B., Martin, S., Temming, L. A., Colditz, G. A., Macones, G. A., & Tuuli, M. G. (2017) · Journal of Perinatology · doi:10.1038/jp.2017.159 · Cited by 33 · see citing works
Barriers to Postpartum Glucose Testing in Women with Gestational Diabetes Mellitus
Has, P., Kanno, L., Sullivan, A., Clark, M. A., & Werner, E. F. (2018) · American Journal of Perinatology · doi:10.1055/s-0038-1667290 · Cited by 31 · see citing works
Self-citationImpact of an intensive follow-up program on the postpartum glucose tolerance testing rate
Figueroa, H. M., Daley, J., Breault, P., Lopes, V., Paine, V., Goldman, D., Francis, M. J., Delgado, B., & Coustan, D. R. (2014) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-014-3157-0 · Cited by 30 · see citing works
Immediate Postpartum Glucose Tolerance Testing in Women with Gestational Diabetes: A Pilot Study
Muscat, J. C., Heo, H. J., Islam, S., Vintzileos, A. M., & Dinglas, C. (2017) · American Journal of Perinatology · doi:10.1055/s-0037-1606620 · Cited by 16 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
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
Gestational Diabetes: Overview with Emphasis on Medical Management
Lende, M., & Rijhsinghani, A. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249573 · Cited by 240 · see citing works
Ndumele, C. E., Rodriguez, F., Dixon, D. L., Khan, S. S., Mukherjee, D., Bajaj, M., Bangalore, S., Bozkurt, B., Breathett, K., Clarke, S. L., et al. (2026) · JACC · doi:10.1016/j.jacc.2026.03.056 · Cited by 90 · see citing works
American College of Obstetricians and Gynecologists (2024) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000005612 · Cited by 46 · see citing works
LeBlanc, E. S., Brooks, N., Davies, M., & Chatterjee, R. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae655 · Cited by 11 · see citing works
- Authors
- Werner, E. F., Has, P., Rouse, D., & Clark, M. A.
- Affiliations
- Brown University (US)
- Corresponding author
- Werner, Erika F.
- Venue
- American Journal of Obstetrics and Gynecology
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 223
- Issue
- 3
- Pages
- 439.e1-439.e7
- ISSN
- 0002-9378 (ISSN-L)
- OpenAlex
- W3031088801
- Cited by
- 52
- References
- 17
- Citations by year
- 2026: 16 · 2025: 11 · 2024: 13 · 2023: 4 · 2022: 3 · 2021: 2 · 2020: 3
- FWCI
- 1.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- American Journal of Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association
- 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, impaired glucose metabolism, postpartum diabetes, HbA1c, diagnostic accuracy, screening timing, receiver operating characteristic, sensitivity and specificity, postpartum women
- MeSH terms
- Adult, Female, Glucose Tolerance Test, Glycated Hemoglobin, Humans, Predictive Value of Tests, Pregnancy, Prenatal Care, Prospective Studies, Time Factors, Cohort Studies, Diabetes, Gestational
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
