Effect of Social Drivers of Health on Screening for Type 2 Diabetes in Individuals With Gestational Diabetes During...

To prospectively evaluate postpartum diabetes screening rates among individuals with gestational diabetes mellitus (GDM) offered testing during the delivery hospitalization or at 4-12 weeks postpartum compared with historic outpatient-only screening and to assess the role of social and structural drivers of health.

This retrospective study compared patients with GDM who delivered between January 1 and December 31, 2023 (retrospective cohort), and underwent outpatient screening at 4-12 weeks postpartum with a 75-g 2-hour oral glucose tolerance test (OGTT) with a prospective cohort (June 24-November 5, 2024) of the first 100 patients who underwent screening in the immediate postpartum delivery hospitalization or at 4-12 weeks postpartum. Demographic, social, and structural drivers of health were collected. A sample size of 95 in the prospective group provided 80% power to detect a 50% increase in screening from 32% to 48% (α=0.05).

A greater number of individuals in the prospective cohort completed the OGTT (77.3%, 75/97) compared with the retrospective cohort (31.7%, 98/309, P<.001). Multivariate logistic regression analysis adjusted for social vulnerability index, body mass index (BMI), race, ethnicity, and distance from clinic demonstrated that patients in the prospective cohort who were offered screening either in the immediate postpartum delivery hospitalization or 4-12 weeks postpartum were more likely to complete the OGTT compared with those in the retrospective cohort (adjusted odds ratio 7.6, 95% CI, 4.4-13.7). No differences in sociodemographic characteristics or social or structural drivers of health were found in either the retrospective or prospective cohort between patients who completed and those who did not complete screening.

The updated guidance from the American College of Obstetricians and Gynecologists to offer an OGTT during delivery hospitalization in addition to the traditional outpatient approach may increase completion rates across the entire postpartum population regardless of sociodemographic, social, or structural drivers of health. Rather than targeting specific groups, this approach addresses universal barriers to postpartum screening, enhancing overall adherence to postpartum diabetes screening recommendations.