Postpartum Diabetes Screening: Compliance in the COVID Era

ABSTRACT

Objective: Most women with gestational diabetes (GDM) will not undergo recommended postpartum screening, and it is unknown if COVID has impacted these low rates of follow-up. The objective of this study was to determine the rate at which patients completed their recommended postpartum diabetes screening and compare compliance prior to and during the COVID pandemic. Study Design: This was a retrospective review of patients diagnosed with GDM who delivered at a single institution from April 1, 2019 – March 31, 2021. The main outcome was difference in compliance with recommended 2-hour oral glucose tolerance test prior to and during the COVID pandemic. For the purpose of this study, compliance was defined as completion from 4 weeks to 6 months postpartum. Secondary outcomes were maternal and neonatal outcomes and the prevalence of impaired glucose tolerance postpartum among women who completed the screening. Univariate analysis was performed to compare the two populations. Results: During the study period, 220 patients met inclusion criteria. Among these patient, 104/220 (47.3%) were considered pre-COVID deliveries, defined as delivery prior to March 1, 2020. Baseline characteristics including age, parity, and ethnicity were similar between the two groups (p > 0.05). Diet-controlled diabetes was more prevalent during the COVID pandemic (74.1% versus 61.5%, p = 0.045). During the COVID pandemic, providers more frequently ordered postpartum screening (92.2% vs 81.7%, p = 0.020). Among the patients with screening tests ordered, approximately one third of patients completed recommended postpartum screening in both groups (p > 0.05) and similar rates of prediabetes and diabetes were observed (25.0% versus 37.5% during COVID and prior to the COVID pandemic, respectively, p > 0.05). Conclusion: Overall, the rate of postpartum diabetes screening is poor and remained stable prior to and during the COVID pandemic. Alternative strategies such as inpatient testing prior to hospital discharge may need to be considered.