Objective : Gestational Diabetes Mellitus (GDM) is defined as any degree of glucose intolerance with onset or initial recognition during pregnancy. Its prevalence is 6-10% of pregnancies. Complications of GDM include preeclampsia, fetal macrosomia and development of T2DM after pregnancy. Studies have shown that 30-70% of women will develop T2DM in 15 years after index GDM. Professional organizations recommend that all women with GDM undergo a 2-hour 75-g OGTT 6 to 12 weeks postpartum. Screening rates are low and vary from 14% in usual care to 60% in a randomized control trials. Barriers to postpartum glucose testing include lack of communication between health providers, domestic obligations, lack of education, lack of support, and lack of access to healthcare. This study was the first intervention to identify women with GDM during their child’s 2-month well baby visit.
Methods : All biological mothers aged 18 years of age or older who presented to the University of Maryland Midtown Pediatric Clinic for their baby’s two month well baby visit from 3/1/15 – 3/31/16 were included. They were given a seven-question survey to help identify possible GDM during pregnancy. Women who were screened positive were contacted to set up an appointment at the University of Maryland Center for Diabetes and Endocrinology.
Results : 207 surveys were completed. While 32 women screened positive (15.5%), only 17/32 had GDM and were willing to be contacted by the study. Of the 17 women, only 9 women (53%) could be contacted after completion of the survey by the investigators despite multiple efforts. 8 patients were scheduled but only 4 made it to the appointment. 3 patients were diagnosed with diabetes. Overall, the survey intervention resulted in a 24% screening rate for diabetes in postpartum women diagnosed with GDM.
Discussion : Multiple methods have been tried to increase rates of postpartum OGTT in women diagnosed with GDM including mailings, text messages, and phone calls with mixed results. The strength of our study was its novelty in targeting the pediatric clinic as a screening location to identify women who had GDM. The rate of confirmed GDM in our study was 8% which is consistent with national data. The weakness of our study was the need for a subsequent appointment to screen women with an OGTT which created an additional barrier to care.
Conclusion : This study suggests that the 2 month well baby visit may provide a unique screening opportunity to catch missed cases of appropriate GDM follow up. However, actually getting women to their providers for the OGTT remains a challenge. A more patient centered model of care may result in better screening rates.
University of Maryland
Ann is a first year endocrinology fellow at the University of Maryland.