This study aimed to assess the accuracy of measuring fasting plasma glucose (FPG) within 24-48 h postpartum in women with gestational diabetes mellitus (GDM) as a predictor for abnormal 6-12-week postpartum oral glucose tolerance test (OGTT).

A retrospective cohort study (2012-2021) included women with GDM and singleton pregnancies who had FPG levels recorded 24-28 h postpartum and underwent a 6-12-week OGTT. The study compared the predictive accuracy of these FPG readings with the OGTT results.

Among 3128 GDM patients, 1163 (37.2 %) had a postpartum OGTT, with 935 (80.2 %) showing normal FPG (<100 mg/dL). In low-risk GDM cases (managed by lifestyle modifications), 86.15 % had normal postpartum FPG. Normal 24-48 h FPG readings, especially in low-risk GDM cases, had a high negative predictive value (NPV of 99.3 %) for type-2 diabetes at the 6-12-week OGTT, but a lower NPV (85.8 %) for predicting future glucose intolerance.

Immediate postpartum FPG testing effectively excludes low-risk GDM women with regards to future type-2 diabetes and reasonably excluded future glucose intolerance in this group. Due to low compliance with standard OGTT, postpartum FPG could be a more practical predictive tool for diabetes in low-risk GDM cases.

In gestational diabetes mellitus (GDM), a postpartum oral glucose tolerance test (OGTT) is recommended. However, poor adherence to this procedure has been described, and the time required is one of the reasons. Our aims were to identify predictive factors for abnormal 2-h reclassification OGTT values, including OGTT 1-h glucose, and, if it was a factor, to determine the 1-h cutoff point that best identifies abnormal values at 2 h.

This was a retrospective study of 769 patients diagnosed with GDM between 2014 and 2019 in a tertiary center. The sample was divided into two groups according to the presence/absence of abnormal 2-h reclassification values, and predictive factors were studied. To determine the 1-h glycemia cutoff point capable of identifying 2-h changes, a ROC curve was drawn and the Youden index was used.

The mean age of included women was 33.6 ± 4.95 years: 70 of them (9.1%) had an abnormal 2-h test result. Women with a history of GDM (OR = 3.41, p = .012) and higher 1-h glycemia value (OR = 1.05, p < .001) had a higher risk of developing an abnormal 2-h test result. One-hour glycemia ≥ 142 mg/dL had a sensitivity of 91.4% and specificity of 75.1% to identify changes in the test at 2 h; area under the curve to predict 2-h changes was 0.90 (CI 95%: 0.86 - 0.93).

Glucose measurement at 1 h predicts alterations at 2 h in the reclassification test with excellent diagnostic accuracy, and the cutoff point of  ≥ 142 mg/dL presents high sensitivity. These findings could serve as a foundation for a possible future redefinition of the OGTT procedure, but further investigation is required.

Recent studies have shown that gestational diabetes mellitus (GDM) is associated with an increased risk for cardiovascular disease. GDM has also been shown to be a risk factor for type 2 diabetes (T2DM) after pregnancy. However, there is limited evidence regarding the role of intercurrent T2DM on the relationship between GDM and future CVD. Thus, we investigated the risks of incident cardiovascular events among women with GDM during pregnancy compared to women without GDM and whether the increased CVD risk is dependent on intercurrent development of T2DM. We conducted a population-based retrospective cohort study using the Korean National Health Insurance Service claims database. Outcomes were the first occurrence of any CVD (myocardial infarction, treatment with coronary revascularization, heart failure, and cerebrovascular disease). Cox proportional hazard models were used to assess the association between GDM and incident CVD events, using landmark analysis at 4 years. A total of 1,500,168 parous women were included in the analysis, of which 159,066 (10.60%) had GDM. At a median follow-up of 12.8 years, 13,222 incident cases of total CVD were observed. Multivariable-adjusted hazard ratio for total CVD among women with prior GDM, compared with those without GDM, was 1.08 (95% CI 1.02-1.14). Further classifying GDM by progression to T2DM in relation to total CVD risk indicated a positive association for GDM with progression to T2DM vs no GDM or T2DM (HR 1.74; 95% CI 1.40-2.15), and no statistically significant association for GDM only (HR 1.06; 95% CI 1.00-1.12). GDM with subsequent progression to T2DM were linked with an increased risk of cardiovascular diseases. These findings highlight the need for more vigilant postpartum screening for diabetes and the implementation of diabetes interventions in women with a history of GDM to reduce future CVD risk.

Pregnancy presents an opportunity to engage veterans in health care. Guidelines recommend primary care follow-up in the year postpartum, but loss to follow-up is common, poorly quantified, and especially important for those with gestational diabetes (GDM) and hypertension. Racial maternal inequities are well-documented and might be exacerbated by differential postpartum care. This study explores variation in postpartum re-engagement in U.S. Department of Veteran Affairs health care system (VA) primary care to identify potential racial/ethnic inequities in this care transition.

We conducted a complete case analysis of the 2005-2014 national VA birth cohort (n = 18,414), and subcohorts of veterans with GDM (n = 1,253), and hypertensive disorders of pregnancy (HDP; n = 2,052) using VA-reimbursed discharge claims and outpatient data. Outcomes included incidence of any VA primary care visit in the postpartum year; in age-adjusted logistic regression, we explored race/ethnicity as a primary predictor.

In the year after a VA-covered birth, the proportion of veterans with one or more primary care visit was 53.8% overall, and slightly higher in the GDM (56.0%) and HDP (57.4%) subcohorts. In adjusted models, the odds of VA primary care follow-up were significantly lower for Black/African American (odds ratio, 0.87; 95% confidence interval, 0.81-0.93), Asian (odds ratio, 0.76; 95% confidence interval, 0.61-0.95), and Hawaiian/other Pacific Islander (odds ratio, 0.73; 95% confidence interval, 0.55-0.96) veterans, compared with White veterans. Among the subcohorts with GDM or HDP, there were no significant associations between primary care and race/ethnicity.

One-half of veterans re-engage in VA primary care after childbirth, with significant racial differences in this care transition. Re-engagement for those with the common pregnancy complications of HDP and GDM is only slightly higher, and less than 60%. The potential for innovations like VA maternity care coordinators to address such gaps merits attention.

Due to diverging international recommendations, the unclear role of HbA1c and the lack of longitudinal data, we investigated the accuracy of diagnostic tests in the early and late postpartum in women with gestational diabetes (GDM) especially to predict future glucose-intolerance.

This longitudinal cohort included 967 women with GDM from 2011 to 2020. A 75-g oGTT and HbA1c were performed at 4-12 weeks (early) postpartum. FPG and HbA1c were measured at 1 and 3-year (late) postpartum. ADA criteria were used as gold standards. At all time-points (4-12 weeks, 1-year and 3-year postpartum) women with diabetes and prediabetes were grouped together and referred to as glucose-intolerant, because at most 3% of the entire cohort population had diabetes at any time-point.

The prevalence of glucose-intolerance in the early postpartum was higher using FPG and HbA1c (27.5%) than oGTT criteria (18.2%). Only 48-80% of women diagnosed with glucose-intolerance in the early postpartum actually remained intolerant. This was especially low when FPG or oGTT were combined with HbA1c (1-year: ≤ 62% and 3-years: ≤ 50%). Regardless of the test used, 1/3 of women with initially normal glucose-tolerance became glucose-intolerant in the late postpartum. HbA1c was unrelated to iron status/intake, remained stable throughout, but poorly predicted future glucose-intolerance. In the longitudinal analyses, all diagnostic tests in the early postpartum showed acceptable specificities (74-96%) but poor sensitivities (all < 38%) to predict glucose-intolerance after only 10-months. At 1-year postpartum however, the combination of FPG and HbA1c could best predict glucose-intolerance 2-years later.

Combining FPG with HbA1c at 1-year postpartum represents a reliable choice to predict future glucose-intolerance. Given the poor prediction of tests including oGTT in the early postpartum, focus should rather be on continuous long-term screening.

We aimed to identify the postpartum metabolic factors that were associated with the development of diabetes in women with a history of gestational diabetes mellitus (GDM). In addition, we examined the role of the oral glucose tolerance test (OGTT) in the prediction of future diabetes.

We conducted a prospective study of 179 subjects who previously had GDM but did not have diabetes at 2 months postpartum. The initial postpartum examination including a 75-g OGTT and the frequently sampled intravenous glucose tolerance test (FSIVGTT) was performed 12 months after delivery, and annual follow-up visits were made thereafter.

The insulinogenic index (IGI30) obtained from the OGTT was significantly correlated with the acute insulin response to glucose (AIRg) obtained from the FSIVGTT. The disposition indices obtained from the OGTT and FSIVGTT were also significantly correlated. Women who progressed to diabetes had a lower insulin secretory capacity including IGI30, AIRg, and disposition indices obtained from the FSIVGTT and OGTT compared with those who did not. However, the insulin sensitivity indices obtained from the OGTT and FSIVGTT did not differ between the two groups. Multivariate logistic regression analysis showed that the 2-hour glucose and disposition index obtained from the FSIVGTT were significant postpartum metabolic risk factors for the development of diabetes.

We identified a crucial role of β-cell dysfunction in the development of diabetes in Korean women with previous GDM. The 2-hour glucose result from the OGTT is an independent predictor of future diabetes. Therefore, the OGTT is crucial for better prediction of future diabetes in Korean women with previous GDM.

The world's pre-eminent diabetes, obstetric, endocrine, and health organizations advocate a plethora of diverse algorithms for the screening, diagnosis, management, and follow-up of gestational diabetes mellitus (GDM). Additionally, there are regional recommendations of local health societies. Several of these proposals for GDM are contentious because some of them were developed from unscientific studies, based on expert-opinion, catered to preserve resources, and subjectively modified for convenience. Due to the wide variety of choices available, the approach to GDM can be extremely diverse even within the same hospital. This lack of consensus creates major problems in addressing prevalence, complications, efficacy of treatment, and follow-up of GDM. Moreover, it becomes nearly impossible to compare the numerous studies. Furthermore, the lack of consensus confuses the health care providers of obstetric health who look to the experts for guidance. Therefore, a clear, objective, "evidence-based" global approach, which is simple, easy to follow, and validated by corroborative research, is crucial. We contend that, despite decades of research, a single acceptable global guideline is not yet on the horizon.

Fasting plasma glucose (FPG) as a screening test for gestational diabetes mellitus (GDM) has had a checkered history. During the last three decades, a few initial anecdotal reports have given way to the recent well-conducted studies. This review: (1) traces the history; (2) weighs the advantages and disadvantages; (3) addresses the significance in early pregnancy; (4) underscores the benefits after delivery; and (5) emphasizes the cost savings of using the FPG in the screening of GDM. It also highlights the utility of fasting capillary glucose and stresses the value of the FPG in circumventing the cumbersome oral glucose tolerance test. An understanding of all the caveats is crucial to be able to use the FPG for investigating glucose intolerance in pregnancy. Thus, all health professionals can use the patient-friendly FPG to simplify the onerous algorithms available for the screening and diagnosis of GDM - thereby helping each and every pregnant woman.

To assess the concordance between the HbA1c and the oral glucose tolerance test (OGTT) for the diagnosis of diabetes and prediabetes following gestational diabetes (GDM) in an ethnically diverse population.

Women with GDM underwent a concurrent OGTT and HbA1c test 6-12 weeks postpartum.

There were 114 women with GDM who had a 75 g 2-h OGTT and HbA1c at 9.0 ± 3.2 weeks postpartum. Five subjects had diabetes using OGTT criteria, and 4 by HbA1c criteria. No subjects had diabetes on both criteria. The overall concordance between the OGTT and HbA1c for the diagnosis of diabetes, prediabetes, or normal glucose tolerance was only 54% (κ coefficient 0.058, p=0.41). Gravidity, the 2-h glucose level on the OGTT during pregnancy, and the 3rd trimester HbA1c predicted discordance between the postpartum OGTT and HbA1c.

There is poor concordance between the OGTT and HbA1c for the diagnosis of diabetes and prediabetes following GDM. This reflects that the two tests measure different aspects of dysglycemia. In the post-GDM population, the HbA1c misses cases of diabetes as identified by the OGTT. We recommend that the OGTT be retained for postpartum diabetes testing following GDM.

To explore factors associated with postpartum glucose screening among women with Gestational Diabetes Mellitus (GDM).

A retrospective study using linked records from women with GDM who gave birth at Cairns Hospital in Far North Queensland, Australia, from 1 January 2004 to 31 December 2010.

The rates of postpartum Oral Glucose Tolerance Test (OGTT) screening, while having increased significantly among both Indigenous* and non-Indigenous women from 2004 to 2010 (HR 1.15 per year, 95%CI 1.08-1.22, p<0.0001), remain low, particularly among Indigenous women (10% versus 27%, respectively at six months postpartum). Indigenous women in Cairns had a longer time to postpartum OGTT than Indigenous women in remote areas (HR 0.58, 0.38-0.71, p=0.01). Non-Indigenous women had a longer time to postpartum OGTT if they: were born in Australia (HR 0.76, 0.59-1.00, 0.05); were aged <25 years (HR 0.45, 0.23-0.89, p=0.02); had parity >5 (HR 0.33, 0.12-0.90, p=0.03); smoked (HR 0.48, 0.31-0.76, p=0.001); and did not breastfeed (HR 0.09, 0.01-0.64, p=0.02).

Postpartum diabetes screening rates following GDM in Far North Queensland are low, particularly among Indigenous women, with lower rates seen in the regional centre; and among non-Indigenous women with indicators of low socioeconomic status.

Strategies are urgently needed to improve postpartum diabetes screening after GDM that reach women most at risk.