Table 1.
Summary of Studies Included in the Systematic Review and Meta-Analysis
| Author (publication year) | Study method | Study setting, State, Institution, Data source | GDM identification | Postpartum screening time frame and test(s) | Women with at least 1 visit after delivery n (%) | Overall postpartum diabetes screening n (%) |
Postpartum diabetes screening by race/ethnicity n (%)a |
||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| N = 96,439 | White n = 36,807 | Black n = 7,315 | Hispanic n = 18,336 | Asian n = 12,269 | Other n = 7,203b | ||||||
| Studies with no intervention to improve screening | |||||||||||
| Kim et al.33 | Retrospective cohort | Academic MI University of Michigan EMR |
ICD9 code + Chart review +5% check of 3 hours oGTT (C/C) | ≥6 weeks Any labs with glucose, Hb A1C, FPG, oGTT |
447/533 (84) | 204/533 (38) | 159/439 (36) | 31/60 (52) | NR | NR | 14/34 (41) |
| Russell et al.38 | Retrospective cohort | Academic DIP clinic RI Brown University EMR |
3 hours oGTT (C/C) | After delivery 5–8.5 weeks IQR 2 hours oGTT, FPG |
265/344 (77) | 156/344 (45) | 37/99 (37) | 37/69 (54) | 64/139 (46) | NR | 18/37 (49) |
| Almario et al.26 | Retrospective cohort | Academic PA Thomas Jefferson University EMR + Quest, Labcorp data |
3 hours oGTT (C/C) + clinician dx | 5–12 weeks 2 hours oGTT, FPG |
90/90 (100) | 18/90 (20) | 4/29 (14) | 5/29 (17) | 3/10 (30) | 6/22 (27) | NR |
| Dietz et al.29 | Retrospective cohort | Integrated health system OR, WA Kaiser NW EMR |
FPG ≥126 or 1 hour GCT ≥200 or 3 hours oGTT (NDDG), or ICD-9 + insulin or glyburide | ≤12 weeks 2 hours oGTT, FPG |
356/356 (100) | 251/356 (71) | 122/196 (62) | 6/8 (75) | 47/58 (81) | 75/89 (84) | 1/4 (25) |
| Ferrara et al.31 | Prospective cohort | Integrated health system Northern CA Kaiser EMR |
3 hours oGTT (NDDG) | 6 weeks to 12 months 2 hours oGTT, FPG, Hb A1C after 12 weeks |
NR | 5,524/14,448 (38) | 1,547/4,652 (33) | 177/677 (26) | 1,497/3,692 (41) | 1,729/3,799 (46) | 309/737 (42) |
| Lawrence et al.34 | Retrospective cohort | Integrated health system Southern CA Kaiser EMR |
3 hours oGTT (C/C) | 7 days to 6 months 2 hours oGTT or FPG |
11,164/11,825 (94) | 5,939/11,825 (50) | 1,184/2,484 (48) | 219/804 (27) | 3,139/6,144 (51) | 1,333/2,259 (59) | 64/134 (48) |
| Stasenko et al.40 | Retrospective cohort | Academic Northern CA UCSF EMR |
3 hours oGTT (C/C) | 6 months 2 hours oGTT or FPG |
NR | 251/745 (34) | 66/238 (28) | 16/56 (29) | 18/101 (18) | 146/338 (43) | NR |
| Blatt et al.27 | Retrospective cohort | Quest Data Warehouse U.S. National |
2 hours oGTT (IADPSG) | 6 months 2 hours oGTT, 3 hours oGTT, FPG, RPG, Hb A1C |
NR | 4,486/23,299 (19) | 774/5,236 (15) | 209/1,291 (16) | 393/2,209 (18) | 244/1,272 (19) | 125/663 (19) |
| Hale et al.15 | Retrospective cohort | Medicaid SC Administrative claims, birth certificate, hospital discharge data |
ICD9 for GDM + CPT code for oGTT in pregnancy | 5–13 weeks 2 hours oGTT, FPG, RPG |
5,144/6,239 (83) | 214/6,239 (3) | 102/2,949 (3) | 98/2,949 (3) | NR | NR | 12/276 (4) |
| McCloskey et al.35 | Cross sectional | Academic MA Boston Medical Center EMR ± Administrative claims |
ICD9 | 6 months 2 hours oGTT, FPG, Hb A1C |
333/415 (80) | 97/415 (23) | 5/30 (17) | 70/274 (26) | 12/52 (23) | 4/48 (8) | NR |
| Mendez-Figueroa et al.43 | Retrospective cohort | Academic DIP clinic RI Brown University EMR |
3 hours oGTT (C/C) | 8–159 days 2 hours oGTT |
NR | 201/414 (49) | 32/100 (32) | 27/53 (51) | 83/162 (51) | 40/62 (65) | 19/36 (53) |
| Oza-Frank36,c | Cross sectional | PRAMS CO, MN, UT, NYC Survey |
Self-report | <4 months NR |
NR | 402/829 (48) | (51) | (55) | (43) | NR | (51) |
| Paez et al.37 | Retrospective cohort | Medical group MA Harvard Vanguard EMR |
ICD9 + 3 hours oGTT or test strip script | ≥6 weeks 2 hours oGTT, FPG; Hb A1C after 12 weeks |
NR | 118/139 (85) | 63/74 (85) | 14/20 (70) | NR | 27/29 (93) | 12/14 (86) |
| Eggleston et al.30 | Retrospective cohort | Private health plan U.S. National Administrative claims |
ICD9 (1 inpatient or 2 outpatient) | 12 months Any labs with glucose 2 hours oGTT, FPG, Hb A1C |
26,125/32,253 (81) | 7,722/32,253 (24) | 4,252/19,161 (22) | 126/597 (21) | 1,039/4,086 (25) | 1,219/3,743 (33) | 1,061/4,588 (23) |
| Rosenthal et al.51 | Retrospective cohort | Academic DIP clinic MA Brigham & Womens EMR |
3 hours oGTT (C/C) or clinician dx | 6–12 weeks 2 hours oGTT |
296/404 (73) | 155/404 (38) | 41/122 (34) | NR | NR | NR | 114/282 (40) |
| Battarbee and Yee44 | Retrospective case-control | Academic IL Northwestern EMR |
NR | 4 months 2 hours oGTT |
560/683 (82) | 279/683 (41) | 60/164 (37) | 58/149 (39) | 70/181 (39) | 43/74 (58) | 48/115 (42) |
| Jones et al.47 | Cross sectional | PRAMS CO, MA Survey |
Self-report | <4 months NR |
NR | 313/584 (54) | 109/222 (49) | 33/50 (66) | 93/191 (49) | 68/100 (68) | 10/21 (48) |
| Rosenbloom et al.48 | Retrospective cohort | Academic MD University of Maryland EMR |
3 hours oGTT (C/C) | ≥6 weeks 2 hours oGTT |
98/118 (83) | 16/118 (14) | NR/36 | 7/68 (10) | NR | NR/7 | NR/7 |
| Werner et al.49 | Prospective cohort | Academic RI Brown University EMR |
3 hours oGTT (C/C) or GCT ≥200 | 12 weeks 2 hours oGTT |
258/300 (86) | 126/300 (42) | 84/214 (39) | 10/22 (45) | 17/50 (34) | 10/23 (43) | 5/14 (36) |
| Studies with intervention to improve screening with a non-intervention “control” | |||||||||||
| Cahill et al.42 | Retrospective cohort (historical control) | FQHC NJ EMR |
NR | Before postpartum visit 2 hours oGTT, FPG |
52/71 (70) | 7/74 (9) | NA | NA | 7/74 (9) | NA | NA |
| Prospective cohort intervention: nurse counseling 1 session | 55/64 (86) | 48/64 (75) | NA | NA | 48/64 (75) | NA | NA | ||||
| Stasenko et al.41 | Retrospective cohort (historical control) | Academic Northern CA UCSF EMR |
3 hours oGTT (C/C) | 6 months 2 hours oGTT or FPG |
NR | 187/560 (33) | 48/173 (28) | 13/46 (28) | 11/76 (14) | 111/256 (43) | NR |
| Retrospective cohort intervention: CDE counseling 1 session—with verbal and written information | NR | 129/245 (53) | 36/68 (53) | 2/12 (17) | 18/36 (50) | 71/121 (59) | NR | ||||
| Schellinger et al.39 | Retrospective cohort (control) | County hospital Midwest EMR |
NR | NR 2 hours oGTT |
220/257 (86) | 156/257 (61) | NR | NR | 87/120 (73) | NR | 69/137 (50) |
| Retrospective cohort intervention: Centering© Pregnancy 4 sessions with one on postpartum risk | 187/203 (92) | 168/203 (83) | NR | NR | 168/203 (83) | NR | NR | ||||
| Studies with intervention to improve screening without a non-intervention “control” | |||||||||||
| Hunt et al.32 | Prospective cohort intervention: nurse case manager three contacts | Academic TX UT-San Antonio EMR |
3 hours oGTT (C/C) | 4–12 weeks 2 hours oGTT, FPG |
NR | 400/707 (57) | NR | NR | 376/648 (58) | NR | 24/59 (41) |
| Carson et al.28 | Prospective cohort intervention: home fingerstick testing | Private practice NJ EMR |
NR | 6 weeks 2 hours oGTT ± FSBS 4 × /day × 2 days |
NR | 20/67 (30) | 9/28 (32) | 1/3 (33) | 1/4 (25) | 0/5 (0) | 8/23 (35) |
| Werner et al.50 | Prospective cohort intervention: reminder calls | Academic MD, RI Johns Hopkins Brown University EMR |
3 hours oGTT (C/C) or GCT ≥200 | 6–12 weeks 2 hours oGTT |
NR | 49/106 (46) | 19/39 (49) | 14/39 (36) | 5/7 (71) | 6/8 (75) | 5/15 (33) |
| Dinglas et al.46 | Prospective cohort intervention: reminder calls | Academic NY NYU-Winthrop EMR |
3 hours oGTT (C/C) or GCT ≥200 | 6–12 weeks 2 hours oGTT |
NR | 35/80 (44) | 9/28 (32) | 2/13 (15) | 14/24 (58) | 9/14 (64) | 1/1 (100) |
| Carter et al.45 | Prospective cohort intervention: reminder calls | Academic MO Washington University in St. Louis EMR |
3 hours oGTT (NDDG) or GCT ≥200 | 6–12 weeks 2 hours oGTT |
43/48 (74) | 31/58 (53) | 13/26 (50) | 14/26 (54) | 5/5 (100) | NR | 4/6 (67) |
a
Not all studies had race/ethnicity data on the whole population. The sum of women with GDM in all race/ethnicity groups does not always equal the total women with GDM.
b
Individuals represented in the “Other” group are indicated here exactly as they are reported in each study. For studies where rates were not reported for white, black, Hispanic and Asian populations, this “Other” category could include some of these groups.
c
Number of individuals (total and screened) in each ethnic/racial group were not reported in this study; only percentages were reported.
C/C, Carpenter and Coustan criteria; CPT, Current Procedural Terminology; DIP, Diabetes in Pregnancy Specialty clinic; EMR, Electronic Medical Record; FPG, fasting plasma glucose; FQHC, Federally Qualified Health Center; FSBS, finger stick blood sugar; GCT, glucose challenge test; GDM, gestational diabetes mellitus; Hb A1C, hemoglobin A1C; IADPSG, International Association of Diabetes and Pregnancy Study Groups; ICD9, International Classification of Diseases, 9th edition; IQR, interquartile range; NA, not applicable; NDDG, National Diabetes Data Group; NR, not reported; oGTT, oral glucose tolerance test; PRAMS, Pregnancy Risk Assessment Monitoring System; RPG, random plasma glucose.