Risk Factors Associated With Noncompliance of the Postpartum Oral Glucose Tolerance Test [11K]

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Abstract

INTRODUCTION:

Standards of medical care in diabetes recommend that women with a history of gestational diabetes mellitus (GDM) be screened for diabetes 6–12 weeks postpartum. At our institution, the 2-hour oral glucose tolerance test (OGTT) has been the test of choice as of January 2012; however, not all candidate patients undergo postpartum testing. We sought to investigate risk factors associated with noncompliance for postpartum OGTT.

METHODS:

Case-series study of all patients diagnosed with GDM at a single tertiary care institution between 2012 and 2014. Cases were identified by accessing our Maternal Fetal Medicine database. Chi square, Mann-Whitney U test, Kruskall-Wallis, and T test analyses were used where appropriate. Logistic regression and linear regression were computed.

RESULTS:

427 patients were diagnosed with GDM during the study period. Follow-up information was available for 384 postpartum patients. Only 213/384 (55%) had a scheduled screening visit and 92/384 (24%) completed the 2 hour OGTT. Risk factors associated with noncompliance (with adjusted P values) included not scheduling the postpartum OGTT (P=.001), missing the postpartum visit (P=.001), fewer number of prenatal visits (P=.04), an elevated 1-hour result on the 3-hour GTT (P=.01), increased birthweight (P=.03), and neonatal weight greater than 4500 grams (P=.04).

CONCLUSION:

Provider's lack of OGTT scheduling is a significant risk factor for noncompliance with postpartum diabetes testing. Other risk factors are related to the success of GDM control. Efforts should focus on educating providers and patients of the importance of postpartum testing, and identifying women with the above listed risk factors.

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