Should women with gestational diabetes be screened at delivery hospitalization for type-2 diabetes?

A new interesting article has been published in Am J Obstet Gynecol. 2019 Jul 24. pii: S0002-9378(19)30942-1. doi: 10.1016/j.ajog.2019.07.035. and titled:

Should women with gestational diabetes be screened at delivery hospitalization for type-2 diabetes?

Authors of this article are:

Waters TP, Kim SY, Werner E, Dinglas C, Carter EB, Patel R, Sharma AJ, Catalano P.

A summary of the article is shown below:

BACKGROUND: Less than half of women with gestational diabetes mellitus (GDM) are screened for type 2 diabetes (DM) postpartum (PP). Other approaches to postpartum screening need to be evaluated including the role of screening during the delivery hospitalization OBJECTIVE: Our aim was to assess the performance of an oral glucose tolerance test (OGTT) administered during the delivery hospitalization compared to the OGTT administered at a 4-12 week PP visit.STUDY DESIGN: We conducted a combined analysis of patient-level data from four centers (six clinical sites) assessing the utility of an immediate postpartum 75g OGTT during the delivery hospitalization (PP1) for the diagnosis of DM compared to a routine 4-12 week postpartum OGTT (PP2). Eligible women underwent a 75g OGTT at both PP1 and PP2. Sensitivity, specificity, negative and positive predictive values of the PP1 test were estimated for diagnosis of DM, impaired fasting glucose (IFG), or impaired glucose tolerance (IGT).RESULTS: 319 women completed a PP1 screening with 152 (47.6%) lost to follow up for the PP2 OGTT. None of the women with a normal PP1 OGTT (n=73) later tested as having type 2 diabetes at PP2. Overall, 12.6% of subjects (n=21) had a change from normal to IFG/IGT or a change from IFG/IGT to DM. The PP1 OGTT 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% CI 6.7-65.3) positive predictive value for DM vs normal/IFG/IGT result. The negative predictive value of having DM at PP2 compared to a normal OGTT (excluding IFT/IGT) at PP1 was 100% (95% CI, 93.5-100) with a specificity of 96.5% (95% CI, 87.9- 99.6).CONCLUSION: A normal OGTT during the delivery hospitalization appears to exclude postpartum type-2 diabetes mellitus. However the results of the immediate postpartum OGTT were mixed when including IFG or IGT. As a majority of women do not return for postpartum diabetic screening, an OGTT during the delivery hospitalization may be of use in certain circumstances where postpartum follow up is challenging and resources could be focused on women with an abnormal screening immediately after the delivery hospitalization.Copyright © 2019 Elsevier Inc. All rights reserved.

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[link-preview url=https://www.ncbi.nlm.nih.gov/pubmed/31351065 forceshot=true]

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