Implementation of New Guidelines for Postpartum Glucose Tolerance Testing in Gestational Diabetes

Gestational diabetes mellitus (GDM) significantly increases the risk of type 2 diabetes mellitus (T2DM) in both mothers and offspring. Although a two-hour oral glucose tolerance test (OGTT) is advised postpartum, adherence remains poor. Our institution has reported suboptimal adherence (<30%) when testing is deferred to 1-3 months postpartum. In May 2024, the American College of Obstetricians and Gynecologists (ACOG) released updated guidance stating that offering a 75g OGTT during delivery hospitalization in the immediate postpartum period is a reasonable alternative to improve screening. This study evaluates the implementation of the updated guideline and examines early outcomes of inpatient postpartum OGTT over a six-month period.

Postpartum patients with GDM received a 75g two-hour OGTT during delivery hospitalization, with samples drawn at zero and 120 minutes. Nursing and phlebotomy teams coordinated logistics to ensure test completion. Data were retrospectively reviewed.

Among 196 eligible patients, 184 (93.9%) completed testing. Of those tested, 24 (13.0%) had abnormal glucose values. Reported barriers included patient refusal, discharge timing, and existing hyperglycemia.

Offering inpatient OGTT led to improved screening adherence and detection of abnormal glucose tolerance. This model may enhance postpartum diabetes prevention efforts in high-risk populations.