At the University of Oklahoma (OU), 8% of pregnant patients have gestational diabetes mellitus (GDM), 18% of whom undergo screening for diabetes mellitus (DM) in the postpartum period. Barriers to obtaining screening at the postpartum visit (PPV) may include lack of education regarding recommendations for postpartum DM screening, afternoon PPV appointment times, patients not fasting at the PPV, and lack of prior knowledge about the length of DM screening. Current practice at OU does not include specific instructions regarding GDM follow up at the time of discharge from the hospital after delivery. We hypothesized that patients with GDM will be more likely to attend the PPV and complete a 2-hour glucose tolerance test (2hGTT) to screen for DM if they are given specific written instructions at the time of discharge from delivery.

A checkbox was added to our institution's pre-existing standard delivery discharge order set to include pre-written postpartum follow up instructions specific to patients with GDM. A list of patients was generated from all deliveries from 8/1/23 to 9/30/23 in the pre-intervention period and from 12/1/2023 to 1/31/2024 in the post-intervention period at our institution. Patients with GDM were included. Patients who did not have a diagnosis of GDM, did not undergo antenatal screening for GDM, had diagnosed or suspected pre-gestational DM, or were treated for DM postpartum were excluded. The following information was abstracted from the medical record: type of gestational diabetes, postpartum fasting finger stick blood sugar value, inclusion of GDM follow up instructions in discharge orders, attendance at PPV, completion of 2hGTT, 2hGTT result, and prenatal care clinic. Attendance at PPV and completion of 2hGTT were compared using a chi-square analysis between the pre- and post-intervention groups.

There were 1236 deliveries performed at OU during the study period, including 605 in the pre-intervention period from 8/1/23 to 9/30/23 and 631 in the post-intervention period from 12/1/23 to 1/31/24. 9.9% of patients in the pre-intervention group and 7.6% in the post-intervention group had a diagnosis of GDM. In the pre-intervention group, there were 38 (63.3%) who attended their PPV compared with 30 (62.5%) in the post-intervention group ( p = 0.93). There were 11 (22.9%) in the pre-intervention group and 10 (20.8%) in the post-intervention group who completed a 2hGTT ( p = 0.74).

We developed an intervention that was consistently implemented in the post-intervention period. Despite consistent inclusion of specific GDM follow up instructions in standard delivery discharge orders, there was not a statistically significant difference in the number of patients who completed a 2hGTT in the post-intervention period compared with the pre-intervention period. Further investigation is needed to determine what other barriers may play a more significant role in preventing completion of a 2hGTT for patients with GDM.