1236-P: Gestational Diabetes Mellitus in Georgia, United States—Factors Associated with Postpartum Glucose Tolerance Testing Completion

Introduction: National guidelines outline completion of postpartum glucose tolerance testing (GTT) as standard of care for those with gestational diabetes mellitus (GDM). Existing surveillance in Georgia has not evaluated factors associated with GTT completion for the state.

Methods: This retrospective cohort study included all patients with GDM identified on birth certificate data in the state of Georgia from 2017-2020. Georgia Pregnancy Risk Assessment Monitoring System data and birth certificate data were used to evaluate patient factors associated with GTT completion. Associations between patient factors and GTT completion were analyzed using Chi-squared tests. The association between ethnicity and GTT completion was further analyzed using Poisson regression.

Results: The GDM rate was 6.61% within the study timeframe. Patients with GDM had high attendance of postpartum care (88.7%); however, only 47.9% of patients overall or 53.2% who attended postpartum care completed GTT. There was no difference between those who did vs. did not complete GTT for maternal age, race, payor status, or comorbidities. Completion rates were higher among those with higher levels of education (54.0% if >16 vs. 24.1% if <12 years) and lower in rural vs. urban residents (43.3% vs. 48.6%). Hispanic women had lower rates of postpartum care attendance (69.0%) and were less likely to complete GTT (13.8%). Odds of GTT completion were lower for Hispanic women even when controlling for education and insurance status (incidence rate ratio 0.91, 95% CI 0.84-0.99).

Conclusion: In Georgia, attendance of postpartum care was high; however, GTT completion rates were unacceptably low. Hispanic ethnicity, lower levels of maternal education, and rural residence were associated with decreased completion rates. These data demonstrate a significant lack of concordance with recommended GDM care guidelines in Georgia and serve as a call to action to standardize care across the state.