Postpartum glucose testing, related factors and progression to abnormal glucose tolerance in a rural population with a known history of gestational diabetes

doi:10.1016/j.dsx.2017.03.035

Diabetes & Metabolic Syndrome: Clinical Research & Reviews

Volume 11, Supplement 1, November 2017, Pages S455-S458

https://doi.org/10.1016/j.dsx.2017.03.035 Get rights and content

Abstract

Aims: Gestational diabetes is a strong risk factor for postpartum progression to glucose intolerance. The aims of the study were to determine rate of postpartum glucose testing , its related factors and rate of progression to glucose intolerance in women who underwent postpartum glucose testing after pregnancy that complicated by gestational diabetes.

Materials: this is a retrospective study and women with gestational diabetes who received prenatal care during 2005-2015 in 3 rural health centers of Khuramshahr (southwestern of Iran) were enrolled. Gestational diabetes mellitus diagnosed by FPG test only, 75g OGTT or GCT. The American Diabetes Association(ADA) criteria applied for definition of postpartum glucose intolerance (pre-diabetes or diabetes) .

Results: Mean duration of follow-up was 29.7 months. BMI≥ 25 was detected in 73.3% and 78.7% of women during pre-pregnancy and postpartum respectively. Overall 45.8% (60/131) of women received postpartum glucose testing. Rate of progression to abnormal glucose tolerance was 23.3% (8.5% pre-diabetes and 15.2% diabetes). Advanced maternal age was associated with postpartum glucose testing (OR 1.066, CI 1.008-1.128, p=0.02).

Discussion: high rate of overweight and obesity, sub optimal rate of postpartum glucose testing and high prevalence of glucose intolerance, highlights the importance of postpartum screening with a more sensitive test and implementation of an intervention program to prevent type 2 diabetes in rural population particularly older women with prior gestational diabetes.

Section snippets

METHODS

In a retrospective study women with gestational diabetes who received prenatal care during 2005–2015 in three rural health centers of Khuramshahr were recruited in 2016. Khuramshahr is located in Khuzestan province (southwestern of Iran) with high fertility rate [19].

High rate of gestational diabetes and low rate postpartum after GDM pregnancy were reported in Ahvaz city, neighbor city with many similar characteristics [10], [20].

A list of women with gestational hyperglycemia and details of

RESULTS

One hundred and thirty-one women with history of GDM were studied mean age was 32.64 (±6.42, SD) years and almost all of them were of Arab ethnicity (94.7%) and housewife (98.5%). Distribution of demographic, obstetrics and clinical characteristics in women with gestational diabetes mellitus is presented in Table 1.

Gestational diabetes mellitus diagnosed by FPG test (9.9%), 75 g OGTT (47.3%) or GCT (42.7%) (Chart 1). Excess BMI (≥25 kg/m²) was detected in 73.3% of women before pregnancy and 78.7%

Rate of Postpartum Glucose Screening

Rate of postpartum glucose screening in this study was 45.8% (60/131). Several studies reported prevalence of postpartum screening rate in women with history of GDM, but few studies focused on rural population. Consistent with our results, suboptimal attendance rate for postpartum glucose test (less than 50%) indicated in many previous reports [18], [22], [23]. This rate varies from 14 to 60% (in usual care versus randomized control trials) [24]. This range has been from 19 to 73% based. A

CONCLUSION

Rate of postpartum glucose testing was less than 50%. Excess BMI was detected in 78.7% of women. Rate of persistent glucose intolerance estimated high using FPG test. These findings highlight the importance of early screening by valid tests and timely implementation of intervention program to prevent type 2 diabetes in rural population. This report is a part of PhD thesis written by Nouhjah which approved by Ahvaz Jundishapur University of Medical Sciences (Registration number:D-9405).

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Cited by (19)

Interventions to increase the uptake of postpartum diabetes screening among women with previous gestational diabetes: a systematic review and Bayesian network meta-analysis
2023, American Journal of Obstetrics and Gynecology MFM
This study aimed to summarize the current interventions aimed at improving postpartum diabetes screening attendance and to compare their effectiveness.
Literature searches were conducted in the Web of Science, Embase, Cochrane Library, CINAHL, and PubMed from inception to March 20, 2023.
Quantitative studies involving an intervention to increase postpartum diabetes screening attendance among women with gestational diabetes mellitus were included.
The Joanna Briggs Institute checklists were used for the quality appraisal of the included studies. A Bayesian network meta-analysis was performed to synthesize the comparative effectiveness of the relevant interventions aimed at improving postpartum diabetes screening rates.
A total of 40 studies were included in this review with pooled data from 17,123 women. Studies included randomized controlled trials (n=11, including 3 US-based studies and 8 non-US–based studies) and nonrandomised studies (n=29, including 13 US-based studies and 16 non-US–based studies). Of the 14 studies that reported screening outcomes, 11 detected early type 2 diabetes at a rate ranging from 2.0% to 23.0%. The types of interventions identified included reminders (eg, postal letters, emails, and phone messages), educational interventions, screening methods and delivery, policy changes, antenatal groups, and multimodal interventions. Based on the network meta-analysis from randomized controlled trials, antenatal group intervention, which refers to antenatal patient education delivered in groups (1 US-based study), had the highest probability to be the most effective intervention (odds ratio, 10; 95% confidence interval, 1.6–77.0), followed by one-to-one educational intervention with written educational materials or counselling (odds ratio, 6.9; 95% confidence interval, 3.6–16.0). The results from nonrandomized studies indicated that flexible screening methods and delivery (2 US-based studies) had the greatest impact on screening uptake (odds ratio, 3.9; 95% confidence interval, 1.8–10.0), followed by educational interventions (1 US-based study and 2 non-US–based studies) with antenatal patient education and written educational materials (odds ratio, 3.4; 95% confidence interval, 1.9–6.3) and antenatal groups (odds ratio, 3.3; 95% confidence interval, 1.7–6.7).
The presented evidence suggests that antenatal patient education delivered in groups and offering more flexible screening methods were associated with the greatest increase in attendance. The multimodal interventions and reminders could still be important if they were more theoretically grounded and were more integrated into the healthcare system.
Comparing the detection rate of postpartum diabetes in early and 4–12 week postpartum screening tests in women with gestational diabetes mellitus: A systematic review and meta-analysis
2023, Taiwanese Journal of Obstetrics and Gynecology
Gestational Diabetes Mellitus (GDM) is one of the critical risk factors for diabetes mellitus (DM). An early postpartum test done in the first few postpartum days can increase the screening rate in women with GDM. Therefore, this systematic review and meta-analysis aimed to combine and analyze data from different studies reporting the detection rate of postpartum diabetes in early and 4–12 week postpartum screening tests in women with GDM. ProQuest, Web of Science, EMBASE, PubMed, Cochrane, and Scopus were searched for English articles from January 1985 to January 2021. Two independent reviewers selected the eligible studies, and the outcomes of interest were extracted. The quality of studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for diagnostic test accuracy studies. Sensitivity and specificity, negative likelihood ratio (NLR), and positive likelihood ratio (PLR) were calculated for the early postpartum oral glucose tolerance test (OGTT). Of 1944 initially identified articles, four studies were included. The sensitivity and specificity of the early test were 74% and 56%, respectively, and the PLR and NLR were calculated as 1.7 and 0.4, respectively. The sensitivity of the early test was higher than the specificity. Based on this sensitivity and specificity, normal cases could be distinguished from abnormal cases, including diabetes and glucose intolerance. Early postpartum OGTT can be advised before hospital discharge. Early testing is a practical option in patients with GDM. Further studies are required to evaluate the early test detection rate for DM and glucose intolerance separately.
Designing a data set for postpartum recall registry of women with gestational diabetes in recent pregnancy and its implementation in Iranian urban health centers
2021, Diabetes and Metabolic Syndrome: Clinical Research and Reviews
Citation Excerpt :
A low rate of postpartum returning for assessment of blood glucose has been reported in developed and developing countries [21–23]. Low rates of postpartum screening have also been reported in this area [22,24,25]. Drafting standard data for clinical registries provide better use of health information and increase the quality of medical care [26].
Gestational diabetes has serious short and long-term consequences for both mother and child. Designing a standard data set and implementing a recall registry system provides opportunities for early interventions in women with a history of gestational diabetes. The present study aims to draft a data set for the gestational diabetes recall registry and its establishment in urban health centers.
To design a data set for gestational diabetes postpartum recall registry a qualitative study has been done from April to June of 2019. In this stage, Information need assessment, Identification of data elements, development of registry software, and field-testing were done. Web-based software was designed in NET language and using a Visual Studio programming environment. Implementation of the postpartum recall registry was started in 6 health centers of Ahvaz city from August 2019.
During six months 163 women with gestational diabetes in current pregnancy were registered. The final data set for the postpartum recall registry included six main groups, 23 subclasses, and 188 data elements. Mandatory data were included 115 elements.
A data set was finalized using a standard method and implemented in urban health centers for six months. Implementing a postpartum registry with standard elements can help manage data and plan for future interventions to reduce modifiable risk factors in this population.
A randomized controlled trial of a web-based education intervention for women with gestational diabetes mellitus
2019, Midwifery
Citation Excerpt :
Although the majority of women in the intervention group had lost weight by 12 weeks postpartum, nearly half remained above pre-intervention weight and were overweight or obese. This is a significant concern for women's health because it is highly predictive for long-term overweight and obesity (Bello et al., 2016; Gilmore et al., 2015) and development of type 2 diabetes (Ghajari et al., 2017). A possible reason for this finding is that several women were overweight or obese when recruited into the study.
This study aimed to investigate changes in maternal body mass index (BMI), blood pressure and glycemic level and infant birthweight using an online educational program compared to standard clinic-based GDM education.
A preliminary randomized controlled trial of the online intervention was conducted in Melbourne, Australia between 2014 and 2015. A total of 110 women were randomized to (1) the control group and received standard clinic-based GDM education; or (2) the intervention group and received standard care plus the web-based education program. Data were collected at two time points: baseline and 12 weeks postpartum. Infant birthweight was also recorded. Chi-squared test, independent t-test and paired t-test were used to compare outcomes.
Pregnant women with newly diagnosed GDM, in the Western region of Melbourne, Australia.
Statistically significant differences were reported between intervention and control groups in maternal weight and glycemia post-intervention (p < 0.05). More women in the intervention group than in the control group reported weight loss post-intervention (90.4% vs 48.3%, p < 0.001), and were considered a healthy weight (BMI = 18.5, 24.9kg/m²) at 12 weeks postpartum (44.2% vs 31%). More women in the intervention group had attended for follow up OGTT at 12 weeks postpartum (96.2% vs 70.7%, p < 0.001). Comparing measures pre- and post-intervention in the intervention group, maternal BMI was lower [(28.60 ± 7.93) vs (29.60 ± 8.32); p = 0.000], maternal systolic blood pressure was increased but within normal range [(108.19 ± 11.80) vs (107.29 ± 12.13); p = 0.001], and maternal glycemic level returned to within normal limits [(4.86 ± 0.42) vs (8.80 ± 2.50); p = 0.026]. Most women in both groups gave birth to normal birthweight infants (92.3% and 94.8%). These findings are offset by differences in the groups at baseline.
Findings suggest that the education intervention had a positive impact on women’s postpartum weight and attendance at OGTT by 12 weeks postpartum. No effect was found on maternal blood pressure or infant birthweight. Further studies with matched intervention and control groups are needed to achieve more definitive conclusions.
The impact of self-reported preconception body mass index on gestational abnormal glucose tolerance in a Chinese center
2018, Journal of Diabetes and its Complications
Citation Excerpt :
The discrepancy in AGT prevalence may be related to the population race, sample size, and diagnostic criteria.3,19 And through the analysis of characteristics of the targeted population, we found that the AGT and normal women groups were unbalanced in the distribution of age, parity and education (p < 0.05), which considerably strengthen the conclusion of previous studies.20,21 Further stratified analysis confirmed that preconception BMI had a greater impact on primiparous group than multiparous one.
To investigate the association between self-reported preconception body mass index (BMI) and the risk of abnormal glucose tolerance (AGT).
Data were obtained from a prospective cohort study conducted in China. We recruited 5305 qualified women who registered during 22–24 gestational weeks. Blood glucose was measured by trained professionals, and other health-related information was recorded prospectively. We used logistic regression to evaluate the relationship between preconception BMI with AGT and its subtypes, after controlling for potential confounders.
649 of the 5305 participants (12.2%) were diagnosed with AGT. The prevalences of AGT in underweight, normal weight, overweight and obese population indicated a significant linear increased trend (8.4%, 11.1%, 20.0% and 27.7%, respectively) (p < 0.001), regardless of parity status. After adjustment for maternal age, education and parity, the adjusted odds ratios of AGT for underweight: OR = 0.82 (95% CI: 0.62, 1.06); overweight: OR = 1.92 (95% CI: 1.54, 2.38); obese: OR = 2.82 (95% CI: 1.88, 4.22) compared with normal weight. Stratified analysis showed preconception BMI had a greater impact on primiparous women.
Our results support an association between self-reported preconception BMI with increased risk of AGT, and it was dependent on parity.
Postpartum risk of diabetes and predictive factors for glucose intolerance in East Asian women with gestational diabetes
2018, Diabetes Research and Clinical Practice
Citation Excerpt :
High Glu120 and high HbA1c levels were associated with reduced insulin secretion and insulin resistance, respectively, at 2 years after delivery. Other reports have also indicated some risk factors for postpartum glucose tolerance [22–28]. Most of the predictive factors for diabetes that are reported in current publications refer to GDM diagnosed using criteria developed before the GDM diagnostic criteria were updated by the IADPSG [29].
Women with a history of gestational diabetes mellitus (GDM) are likely to develop postpartum diabetes mellitus (DM). We examined women in the early stages of pregnancy who were at high risk of postpartum DM progression to establish a follow-up method for early detection.
We performed the oral glucose tolerance test (OGTT) and identified predictive factors for postpartum impaired glucose tolerance (IGT) or DM in 77 women after GDM, for 2 years after delivery, retrospectively. Cutoff values for each factor were determined. We classified these women with GDM into four groups using these predictive factors and evaluated postpartum glucose intolerance (GI) in each group.
In total, 44.1% of the women with a GDM history had developed postpartum GI within 2 years. We determined three risk factors for postpartum GI: elevated glucose level 120 min after a 75-g OGTT (Glu120), elevated glycated hemoglobin (HbA1c) level at diagnosis, and perinatal complications. The cutoff Glu120 and the HbA1c level were 155 mg/dl and 5.3% (34 mmol/mol), respectively. Type 2 DM developed in 53.8% of women, and IGT developed in 38.5% of women within 2 years in groups with high Glu120 and high HbA1c.
High-risk groups require careful follow-up observation.

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Original ArticlePostpartum glucose testing, related factors and progression to abnormal glucose tolerance in a rural population with a known history of gestational diabetes

Abstract

Section snippets

METHODS

RESULTS

Rate of Postpartum Glucose Screening

CONCLUSION

Diabetes Metab Syndr

Endocrinol Metab Clin North Am

Prim Care Diabetes

Obstet Gynecol

Global prevalence of diabetes: estimates for the year 2000 and projections for 2030

Diabetes Care

Rising burden of diabetes-public health challenges and way out

Nepal J Epidemiol

National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011

Population health significance of gestational diabetes

Diabetes Care

Diabetes mellitus after GDM

Diabetes

Increasing prevalence of gestational diabetes mellitus a public health perspective

Diabetes Care

Type 2 diabetes after gestational diabetes: the influence of changing diagnostic criteria

World J Diabetes

Metabolic syndrome risk after gestational diabetes: a systematic review and meta-analysis

PLoS One.

Gestational diabetes mellitus: results from a survey of country prevalence and practices

J Matern Fetal Neonatal Med

Gestational diabetes mellitus

Rev Obstet Gynecol

Attenuating type 2 diabetes with postpartum interventions following gestational diabetes mellitus

World J Diabetes

Gestational diabetes and the incidence of type 2 diabetes: a systematic review

Diabetes Care

Original Article
Postpartum glucose testing, related factors and progression to abnormal glucose tolerance in a rural population with a known history of gestational diabetes