Postpartum glucose tolerance screening in women with gestational diabetes in the state of North Carolina

To determine how frequently health care providers taking care of women with gestational diabetes mellitus (GDM) are screening for postpartum glucose tolerance and what practice approaches they are using to care for women with GDM. A mailed survey assessed health care providers' knowledge of GDM and practice patterns. Factors influencing practice protocols for measuring glucose tolerance postpartum were identified. Of 1,002 eligible North Carolina health professionals, 399 responded (40%); 327 of these (82%) were providing prenatal and postpartum care and returned the completed surveys. Almost all providers (98%) screen for GDM, and the majority (97%) use the 50-gram one-hour glucose challenge test. Only 27% of respondents always screen for diabetes mellitus (DM) postpartum. The most common method for screening was the 75-gram two-hour glucose tolerance test (54%). The factors most commonly associated with failure to screen were patients lost to follow-up, patient inconvenience, and inconsistent screening guidelines. A majority (59%) stated that increased reimbursement would have little to no impact on their consistency in providing diabetic counseling. The rate of postpartum glucose tolerance testing is low in this study of providers of postpartum care. Several modifiable barriers to screening were identified. There is a need for improved screening practices and early intervention that could help prevent the complications of DM and benefit subsequent pregnancies in this high risk population.