(813) Risk factors for delayed gestational diabetes mellitus screening

Friday, February 10, 2023

10:30 AM – 12:00 PM

Objective: To test whether the state-mandated third trimester screening for HIV is associated with delayed gestational diabetes (GDM) screening.

Study Design: We conducted a retrospective cohort study of all women who delivered at a single institution between 1/2018-12/2019 and were diagnosed with GDM. We excluded women who received prenatal care outside this system. ACOG recommends screening for GDM between 24-28 weeks, and delayed screening was defined as screening at >29 weeks. Tennessee mandates repeat HIV screening for pregnant women at >28 weeks. We identified a subset of women with HIV and GDM screening performed on the same day (concurrent screening), which presumably was done to minimize additional blood draws. Confounding factors potentially also associated with delayed screening were selected a priori. Because we anticipated delayed prenatal care could delay GDM screening, we performed a secondary analysis, excluding women with late prenatal care (initiated ³20 weeks) to identify clinician factors associated with delayed GDM screening. Modified Poisson regression with robust standard errors was used to identify factors associated with delayed GDM screening.

Results: Between 2018-2019, there were 9,066 deliveries, and 7,381 (81%) had at least one prenatal visit. Of these women, 382 (5.2%) were diagnosed with GDM. Delayed screening occurred in 59 (16%) patients, 84 (23%) had late prenatal care, and 115 (37%) underwent concurrent HIV screening. Differences between women with delayed versus regular GDM screening are presented in Table 1. Delayed GDM screening was associated with gestational age of first prenatal visit, Black race, and concurrent HIV screening. After excluding women with late prenatal care, only concurrent HIV screening was associated with late GDM screening (RR 4.6, 95% CI 2.1-10.3) (Table 2).

Conclusion: State-mandated third trimester HIV screening is associated with delayed GDM screening, highlighting possible unintended consequences of state mandates for third trimester HIV screening.

Primary & Presenting Author(s)

LeAnn Lam, BS (she/her/hers)
Medical Student
Vanderbilt University School of Medicine
Nashville, Tennessee, United States

Coauthor(s)

AP
Alex Pedowitz, BA
University of Miami Leonard M. Miller School of Medicine
Miami, Florida, United States
SO
Sarah S. Osmundson, MD,MSCR
Associate Professor
Vanderbilt University
Nashville, Tennessee, United States