Efficacy of early versus late postpartum DIPSI test in gestational diabetes mellitus women for follow up

Geethalakshmi A.; Saraswathi S.; Kalaivani K.; Anjalakshi C.; Rajesh Jain; Seshiah V.

doi:10.18203/2320-1770.ijrcog20240792

Authors

Geethalakshmi A. Department of Obstetrics and Gynaecology, Madras Medical College, Chennai, Tamil Nadu, India
Saraswathi S. Department of Obstetrics and Gynaecology, Madras Medical College, Chennai, Tamil Nadu, India
Kalaivani K. Department of Obstetrics and Gynaecology, Madras Medical College, Chennai, Tamil Nadu, India
Anjalakshi C. Department of Obstetrics and Gynaecology, The Madha Medical College and Hospital, Chennai, Tamil Nadu, India
Rajesh Jain Department of Medicine, Jain Hospital Research Centre, Kanpur, Uttar Pradesh, India https://orcid.org/0000-0003-2790-4571
Seshiah V. Department of Medicine, The MGR Medical University, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20240792

Keywords:

Postpartum screening, LSM lifestyle modification, Glucose tolerance test GTT, Gestational diabetes mellitus, DIPSI test

Abstract

Background: The present study aimed to evaluate if postpartum gestational diabetes mellitus (GDM) screening can be performed during immediate post-delivery 72 hrs instead of six weeks postpartum for follow-up.

Methods: Total 150 GDM patients were included. The sample size was calculated as 150 with Nimaster2.0 software. GDM patients are enrolled after meeting the exclusion criteria for the study. The GDM diagnosis was made by DIPSI test and treated as per guidelines. After delivery, the Dipsi test was done on PND-3 (PP1). Furthermore, all were kept on LSM irrespective of the glycaemic level DIPSI test was repeated in all Patients after 45 days (PP2).

Results: All 150 patients had a DIPSI test on 3^rd day post-partum (PP1) and repeat test at 45 days (PP2)., Of these, 60 patients (40%) showed negative DIPSI test on P1 and all remained in Group 1, with 63 patients having negative DIPSI test on PP2. 50 patients (33.3%) had blood glucose between 140-199 mg (Group 2) on PP1 and increased to 53 patients in PP2 in 45 days. 40 patients had diabetic (26.6%) value (Group 3) in PP1, and out of them 34 (22.6%) remained in group 3 in PP2 after 45 days post-partum.

Conclusions: This pilot study shows that nearly 60% of the GDM patient have either IGT or diabetic value following delivery on 3^rd day of PP1 and almost similar results in PP2. Hence, we can do the postpartum screening on the postpartum 3^rd day and need not wait for 6 wks when more than 50% is lost for follow-up. This study shows among GDM 60% of them have underlying beta cell dysfunction.

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References

Raja MW, Baba TA, Hanga AJ, Bilquees S, Rasheed S, Haq IU, et al. A study to estimate the prevalence of gestational diabetes mellites in an urban block of Kashmir valley (North India). Int J Med Sci Public Health. 2014;3(2):191-5.

Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care. 2007;30 Suppl 2:S141-6.

McClean S, Farrar D, Kelly CA, Tuffnell DJ, Whitelaw DC. The importance of postpartum glucose tolerance testing after pregnancies complicated by gestational diabetes. Diabet Med. 2010;27(6):650-4.

Weijers RN, Bekedam DJ, Goldschmidt HM, Smulders YM. The clinical usefulness of glucose tolerance testing in gestational diabetes to predict early postpartum diabetes mellitus. Clin Chem Lab Med. 2006;44(1):99-104.

Waters TP, Kim SY, Werner E, Dinglas C, Carter EB, Patel R, et al. Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes? Am J Obstet Gynecol. 2020;222(1):73.e1-73.e11.

Franks PW, Looker HC, Kobes S, Touger L, Tataranni PA, Hanson RL, et al. Gestational glucose tolerance and risk of type 2 diabetes in young Pima Indian offspring. Diabetes. 2006;55(2):460-5.

Ogonowski J, Miazgowski T. The prevalence of 6 weeks postpartum abnormal glucose tolerance in Caucasian women with gestational diabetes. Diabetes Res Clin Pract. 2009;84(3):239-44.

Aberg AE, Jönsson EK, Eskilsson I, Landin-Olsson M, Frid AH. Predictive factors of developing diabetes mellitus in women with gestational diabetes. Acta Obstet Gynecol Scand. 2002;81(1):11-6.

Zhang L, Zheng W, Huang W, Zhang L, Liang X, Li G. Differing risk factors for new onset and recurrent gestational diabetes mellitus in multipara women: a cohort study. BMC Endocr Disord. 2022;22(1):1-3.

Fox R, Kitt J, Leeson P, Aye CYL, Lewandowski AJ. Preeclampsia: risk factors, diagnosis, management, and the cardiovascular impact on the offspring. J Clin Med. 2019;8(10):1625.

Benhalima K, Van Crombrugge P, Moyson C, Verhaeghe J, Vandeginste S, Verlaenen H, et al. Prediction of glucose intolerance in early postpartum in women with gestational diabetes mellitus based on the 2013 WHO Criteria. J Clin Med. 2019;8(3):383.

Stasenko M, Cheng YW, McLean T, Jelin AC, Rand L, Caughey AB. Postpartum follow-up for women with gestational diabetes mellitus. Am J Perinatol. 2010;27(9):737-42.

Ghajari H, Nouhjah S, Shahbazian H, Valizadeh R, Tahery N. Postpartum glucose testing, related factors and progression to abnormal glucose tolerance in a rural population with a known history of gestational diabetes. Diabetes Metab Syndr. 2017;11(Suppl 1):S455-s458.

Metzger BE, Buchanan TA, Coustan DR, De Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes care. 2007;30(Supplement_2):S251-60.

Society for Maternal-Fetal Medicine (SMFM); Werner EF, Has P, Rouse D, Clark MA. Two-day postpartum compared with 4- to 12-week postpartum glucose tolerance testing for women with gestational diabetes. Am J Obstet Gynecol. 2020 Sep;223(3):439.e1-439.e7.

Seshiah V. Gestational Diabetes Mellitus Guidelines Released on 10 March GDM Awareness day(birthday of Prof. V Seshiah). Technical Report, 2021.

Aghdam NK, Mousavi S, Hantoushzadeh S, Sahaf F. Comparing early and late postpartum glucose challenge test in patients with gestational diabetes mellitus. Cresc J Medi Biolog Sci. 2019;6(1):123-8.

Tandon N, Gupta Y, Kalra S. Postpartum screening after gestational diabetes mellitus: Aiming for universal coverage. Indian J Endocrinol Metab. 2015;19(1):1-4.

Muche AA, Olayemi OO, Gete YK. Predictors of postpartum glucose challenge in women with gestational diabetes mellitus: a prospective cohort study in Ethiopia based on the updated diagnostic criteria. BMJ Open. 2020;10(8):e036882.

Tovar A, Chasan-Taber L, Eggleston E, Oken E. Postpartum screening for diabetes among women with a history of gestational diabetes mellitus. Prev Chronic Dis. 2011;8(6):A124.

Nabuco A, Pimentel S, Cabizuca CA, Rodacki M, Finamore D, Oliveira MM, et al. Early diabetes screening in women with previous gestational diabetes: a new insight. Diabetol Metab Syndr. 2016;8(1):61.

Mendez-Figueroa H, Dahlke JD, Daley J, Lopes VV, Coustan DR. Prediction of abnormal postpartum glucose tolerance testing in mild gestational diabetes mellitus. J Reprod Med. 2014;59(7-8):393-400.

Eastman LM, de Los Reyes S, Dude A. The association of immediate postpartum glucose values with persistent insulin resistance in patients with gestational diabetes. Am J Obstet Gynecol MFM. 2022;4(2):100526.

Paul JC, Fitzpatrick JJ. Postpartum glucose screening among women with gestational diabetes. Appl Nurs Res. 2020;56:151341.

Linnenkamp U, Greiner GG, Haastert B, Adamczewski H, Kaltheuner M, Weber D, et al. Postpartum screening of women with GDM in specialised practices: Data from 12,991 women in the GestDiab register. Diabet Med. 2022;39(7):e14861.

Anjalakshi C, Balaji V, Balaji MS, Ashalata S, Suganthi S, Arthi T, et al. A single test procedure to diagnose gestational diabetes mellitus. Acta Diabetol. 2009;46(1):51-4.

Colagiuri S, Falavigna M, Agarwal MM, Boulvain M, Coetzee E, Hod M, et al. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Diabetes Res Clin Pract. 2014;103(3):364-72.

Heatley E, Middleton P, Hague W, Crowther C. The DIAMIND study: Postpartum SMS reminders to women with gestational diabetes mellitus to test for type 2 diabetes: a randomized controlled trial - study protocol. BMC Pregn Childb. 2013;13:92.