It's Best to Test in Hospital: Improved Testing Rates with Immediate Postpartum Diabetes Testing in Patients with Gestational Diabetes in a Community-Academic Medical Center.

OBJECTIVE

Immediate postpartum diabetes (IPD) testing on day 1 or 2 shows similar diagnostic value to testing at 4 to 12 weeks' postpartum and achieves higher completion rates. Our institution implemented IPD testing on December 1, 2023, before the American College of Obstetricians and Gynecologists' endorsement, to compare pre and postimplementation testing rates and to assess associated maternal and neonatal outcomes.

STUDY

DESIGN

We conducted a retrospective cohort study of patients with gestational diabetes mellitus (GDM) who delivered at our community-academic medical center before (September 1, 2022-November 15, 2023) and after (December 1, 2023-October 31, 2024) IPD implementation. The preimplementation group underwent outpatient testing 4 to 12 weeks' postpartum. The postimplementation group was tested in-hospital 1 or 2 days' postpartum. Both groups received a 2-h our glucose challenge test. Electronic medical records were queried for demographics, medical and obstetric history, GDM information, and postpartum diabetes testing results. Completion rates, maternal, and neonatal factors were compared across and within cohorts using chi-square tests and t-tests.

RESULTS

Across 155 patients (63 preimplementation, 92 postimplementation), baseline characteristics were similar, excluding age. Testing completion increased nearly 5-fold postimplementation (14.3% [9/63] vs. 68.5% [63/92], p < 0.01). In the postimplementation group, 49% of tested patients had abnormal results (43% impaired glucose metabolism, 6% overt diabetes). Non-English speakers and those with a postpartum length of stay > 1 day were more likely to be tested (22.2 vs. 3.45%, p = 0.02; 98.4 vs. 48.3%, p < 0.01). Neonates in the tested group had a lower mean birth weight (3,137.1 ± 665.1 vs. 3,374.4 ± 484.7 g; p = 0.05), longer nursery stay (2.55 ± 2.2 vs. 1.83 ± 0.69 days; p = 0.03), and more neonatal intensive care unit admissions (20.63 vs. 0%; p = 0.01).

CONCLUSION

IPD testing dramatically improved testing and identified a high prevalence of persistent dysglycemia immediately postpartum. Hospital systems should consider implementing this practice change to improve testing rates and early intervention in postpartum care of patients with GDM.

KEY POINTS: · IPD testing is a feasible and replicable practice.. · IPD testing increased rates nearly 5-fold compared with traditional timing.. · Persistent dysglycemia was identifiable immediately postpartum.. · Longer hospital stays increased the likelihood of testing.. · In-hospital testing may reduce language barriers..