(822) Postpartum diabetes screening before hospital discharge in patients with gestational diabetes: a meta-analysis

Objective:
Individuals with gestational diabetes mellitus (GDM) are at increased risk of persistent glucose intolerance and progression to type 2 diabetes postpartum. Although guidelines recommend screening with a 75-g oral glucose tolerance test (OGTT) at 4–12 weeks postpartum, adherence is low. In July 2024, ACOG suggested that performing the 75-g OGTT on postpartum days 1–4, before hospital discharge, is a reasonable alternative. This systematic review and meta-analysis evaluates the diagnostic accuracy and completion rates of inpatient OGTT performed on postpartum days 1–4, using the 4–12 week OGTT as the reference standard.

Study Design:
We conducted a search of electronic databases and gray literature from January 1, 1985 to July 31, 2024. Eligible studies included individuals with GDM who underwent OGTT prior to hospital discharge and again at 4–12 weeks. Pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (OR), and area under the hierarchical summary receiver operating characteristic (HSROC) curve were calculated using a bivariate random-effects model. Screening adherence was compared using pooled proportions and ORs. Publication bias was assessed via Egger’s test.

Results:
This systematic review and meta-analysis included 12 studies involving 1,528 participants. Pooled sensitivity and specificity of OGTT prior to discharge were 88% (95% CI: 81–93%) and 84% (95% CI: 77–89%), respectively. The diagnostic OR was 1.32 (95% CI: 0.82–2.12), and the HSROC area was 0.91. Positive and negative likelihood ratios were 5.5 and 0.14, respectively. Screening completion was significantly higher prior to discharge (90.4%, 95% CI: 84.3–94.2%) compared to routine 4–12 week testing (57.1%, 95% CI: 46.5–67.1%), with a pooled OR of 5.91 (95% CI: 3.52–9.91). No small-study effects were detected.

Conclusion:
OGTT performed prior to hospital discharge demonstrates good diagnostic accuracy and substantially higher adherence than 4–12 week screening. These findings support prior-to-discharge testing as a practical and effective strategy for postpartum diabetes screening in individuals with GDM.