The persistence of abnormal glucose tolerance after delivery

In the first 7 days after delivery, 270 women who had gestational diabetes and 100 who had normal prenatal glucose tolerance were retested for glucose intolerance. In the group who had gestational diabetes, glucose tolerance remained abnormal by the Mercy Maternity Hospital criterion in 28% of those who had been delivered vaginally and in 43% of those delivered by cesarean. The only abnormal test in the control group was in one of the two women delivered by cesarean, and this test returned to normal by the seventh postoperative day. By 6 weeks postpartum, the incidence of abnormal glucose tolerance was 24 and 30% for patients having vaginal and abdominal deliveries, respectively. The method of infant feeding had no significant influence on the prevalence of abnormal glucose tolerance. We conclude that if a glucose tolerance test has not been performed prenatally, the test is still worthwhile in the immediate puerperium if the possibility of gestational diabetes has been raised by adverse pregnancy outcome, because about one in three diabetics will be thus identified. However, screening in the puerperium is not a substitute for prenatal screening.