Diabetes Screening in U.S. Women with a History of Gestational Diabetes

Objective: To examine individual, socioeconomic and healthcare utilization characteristics of women with a history of gestational diabetes mellitus (GDM) and their associations with diabetes screening, and to estimate their rates of undiagnosed prediabetes and diabetes. Research Design and Methods: Using the National Health and Nutrition Examination Survey (NHANES 2007-2012), we identified 284 women without a self-reported diabetes diagnosis and with a history of GDM who were eligible for diabetes screening. Screening status was defined by self-reported responses to having a blood test for diabetes within the prior 3 years. Undiagnosed prediabetes and diabetes were assessed by HbA1c measurement. Results: Sixty-seven percent of U.S. women with a history of GDM reported diabetes screening within the prior three years. Weighted bivariate analyses showed screened women differed from unscreened women in measured BMI category (p=0.01) and number of health visits in the prior year (p=0.001). In multivariable analysis, screening was associated with a greater number of health visits in the prior year (1 visit vs. 0 visits, adjusted Odds Ratio (AOR) 1.91, 95%CI 0.71-5.18; 2-3 visits vs. 0 visits, AOR 7.05, 95%CI 2.18-22.8; > 4 visits vs. 0 visits, AOR 5.83, 95%CI 2.35-14.46) and higher income (AOR 2.49, 95%CI 1.07-5.78). Overall, 24.4% (95% CI 18.27-31.74) of women had undiagnosed prediabetes and 6.5%, 95% CI (3.66-11.31) of women had undiagnosed diabetes. Conclusions: More health visits in the prior year was associated with diabetes screening. Fewer opportunities for screening may delay early detection, clinical management and prevention of diabetes. Prediabetes in women with a history of GDM may be under recognized and inadequately treated.