Battarbee Ashley N, Yee Lynn M
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Am J Perinatol. 2018 Mar;35(4):354-360. doi: 10.1055/s-0037-1607284. Epub 2017 Oct 11.
This study aims to examine factors associated with postpartum follow-up and glucose tolerance testing (GTT) in women with gestational diabetes mellitus (GDM).
Case-control study of women with GDM at a single institution with available outpatient records (January 2008-February 2016). Women with pregestational diabetes mellitus were excluded. The postpartum follow-up, GTT completion, and the reason for GTT completion failure (provider vs. patient noncompliance) were assessed. Bivariable and multivariable analyses were performed to identify factors associated with postpartum follow-up and GTT completion.
Of 683 women, 82.0% ( = 560) returned postpartum, and 49.8% ( = 279) of those completed GTT. Women with Medicaid and late presentation to care were less likely to return (adjusted odds ratio [aOR]: 0.3, 95% confidence interval [CI]: 0.2-0.6 and aOR: 0.4, 95% CI: 0.2-0.7), but if they did, both factors were associated with increased odds of GTT completion (aOR: 2.0, 95% CI: 1.3-2.9 and aOR: 3.5, 95% CI: 1.8-6.6). Patient and provider noncompliance contributed equally to GTT completion failure. Trainee involvement was associated with improved test completion (aOR: 4.6, 95% CI: 2.4-8.8).
The majority of women with GDM returned postpartum, but many did not receive recommended GTT. Public insurance and late presentation were associated with failure to return postpartum, but better GTT completion when a postpartum visit occurred. Trainee involvement was associated with improved adherence to screening guidelines.
本研究旨在探讨与妊娠期糖尿病（GDM）女性产后随访及葡萄糖耐量试验（GTT）相关的因素。
对一家机构中具有门诊记录（2008年1月至2016年2月）的GDM女性进行病例对照研究。排除孕前糖尿病女性。评估产后随访情况、GTT完成情况以及GTT完成失败的原因（医护人员与患者不依从）。进行双变量和多变量分析以确定与产后随访及GTT完成相关的因素。
683名女性中，82.0%（n = 560）产后复诊，其中49.8%（n = 279）完成了GTT。接受医疗补助且就诊较晚的女性复诊可能性较小（调整优势比[aOR]：0.3，95%置信区间[CI]：0.2 - 0.6；aOR：0.4，95% CI：0.2 - 0.7），但如果她们复诊了，这两个因素都与GTT完成几率增加相关（aOR：2.0，95% CI：1.3 - 2.9；aOR：3.5，95% CI：1.8 - 6.6）。患者和医护人员的不依从对GTT完成失败的影响相同。实习生参与与检查完成情况改善相关（aOR：4.6，95% CI：2.4 - 8.8）。
大多数GDM女性产后复诊，但许多人未接受推荐的GTT。公共保险和就诊较晚与产后未复诊相关，但产后就诊时GTT完成情况较好。实习生参与与筛查指南依从性改善相关。
