Diabetes complicates 5% of all pregnancies. 87.5% are due to gestational diabetes mellitus (GDM). These women are at a high risk of developing Type 2 Diabetes Mellitus and up to 50% will be diagnosed in the following 10 years. Current recommendations are that we carry out an oral glucose tolerance test (OGTT) at 6 weeks postpartum and yearly thereafter. Postnatal testing is suboptimal internationally. The aim of the audit is to determine the uptake of OGTT postnatally and to analyse the results found.
We performed an audit on women presenting to the Diabetic Obstetric High Risk Clinic at Cork University Maternity Hospital with a diagnosis of GDM between March 2009 and March 2010. Information collected included OGTT values at referral, risk factors for the development of GDM, referrals to endocrinology services and postnatal OGTT values.
Details were collected from 197 women. The uptake of screening in the postpartum period was 58%. Of those who had a postnatal OGTT, 3.5% (4/115) had a confirmed diagnosis. The higher the antenatal OGTT, the more likely a positive postnatal OGTT. 42% did not have a postnatal OGTT.18% had inappropriate investigations instead. 69% of patients were referred to the endocrinology services. 42% had a documented risk factor for the development of gestational diabetes.
A 6 week postpartum OGTT is crucial in preventing untreated Type 2 diabetes mellitus. Our data suggests that measures need to be taken to ensure this test is performed.
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