Too busy by baby three? Declining postpartum OGTT attendance despite rising risk  — ASN Events
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Too busy by baby three? Declining postpartum OGTT attendance despite rising risk  (#137)

Ning NZ Zhang 1 2
  1. Diabetes Centre, Bankstown-Lidcombe Hospital, SWSLHD , Bankstown
  2. Faculty of Medicine and Health, University of New South Wales, Sydney

Background 

Women with gestational diabetes mellitus (GDM) are at 7-fold risk for developing type 2 diabetes mellitus (T2DM), with an increased risk with each additional affected pregnancy (1).  

Aim 

To compare postpartum oral glucose tolerance test (OGTT) results in women with recurrent GDM across their first, second and third pregnancies.  

Methods 

We analysed de-identified prospectively collected singleton pregnancy data (1991-2025) from women with three GDM-affected pregnancies at Bankstown-Lidcombe Hospital. Postpartum outcomes included OGTT attendance, dysglycaemia and Type 2 Diabetes Mellitus (T2DM). Paired samples t-tests and McNemar’s test were used to assess statistical significance for continuous and categorical data respectively over subsequent pregnancies. Odds ratios were calculated from 2x2 contingency tables. 

Results 

Of 6678 women with GDM, 196 women had three GDM-affected pregnancies. As shown Table 1, postpartum OGTT attendance declined significantly across successive pregnancies, alongside a concurrent trend towards increasing rates of postpartum dysglycaemia, but similar rates of T2DM.  

Table 1: Comparison of Postpartum Glucose Tolerance Test Results  

  

Index GDM pregnancy   

  

 

n (%)  

Second GDM Pregnancy  

  

 

n (%)  

Third GDM Pregnancy  

  

  

n (%)  

Second vs Index GDM Pregnancy  

 

OR (95% CI)  

Third vs Second GDM  

Pregnancy  

 

OR (95% CI) 

Third vs Index GDM Pregnancy  

 

OR (95% CI) 

OGTT attendance  

84/196 (42.9%) 

66/196 (33.7%) 

43/196 (21.9%) 

 0.5 (0.3 - 0.9)* 

 

 0.3 (0.1 - 0.6)*** 

 

 0.2 (0.1- 0.4)*** 

Post-partum  

Dysglycaemia   

12/84 (14.3%)  

14/66 (21.2%)  

10/43 (23.3%)   

 1.8 (0.5 - 6.0)  

 3.0 (0.6 — 14.8)  

 1.7 (0.4 - 7.0)  

Post-partum  

Type 2 Diabetes  

2/84 (2.4%)  

2/66 (3.0%)   

1/43 (2.3%)   

 N/A 

N/A 

N/A 

 *p<0.05, **p<0.01, ***p<0.001, ****p<0.0001 

Conclusion 

Our results suggest there is a critical gap in post-partum OGTT follow up for women with recurrent GDM despite higher risks of progression to T2DM. Only 1 in 5 women with recurrent GDM after their third pregnancy are presenting for OGTT testing. Special emphasis should be placed on adequate screening and follow up in this high-risk population.

References

  1. Bellamy, L., Casas, J. P., Hingorani, A. D., & Williams, D. (2009). Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. The lancet, 373(9677), 1773-1779.