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Purpose&#xa0;of the review <p>To synthesize current evidence on immediate postpartum (delivery hospitalization) oral glucose tolerance testing (OGTT) following gestational diabetes mellitus (GDM), with a focus on underlying physiology, diagnostic performance, implementation outcomes, and evolving diagnostic criteria, in order to clarify its role in postpartum diabetes screening.</p> Recent findings <p>Emerging physiologic data demonstrate that insulin sensitivity improves rapidly within days of delivery, supporting the feasibility of early postpartum glucose testing. Observational and prospective studies show that immediate postpartum OGTT has high negative predictive value for overt diabetes, suggesting utility as a rule-out test. However, specificity and positive predictive value are limited, and sensitivity is modest, raising concern for overclassification due to transient metabolic changes. A 2023 meta-analysis reported pooled sensitivity of 81% and specificity of 61% for early testing. In contrast, completion rates are consistently higher with inpatient testing compared with traditional 4–12&#xa0;week screening. Real-world implementation studies confirm substantial improvements in screening uptake, with completion rates exceeding 70–80%, but also demonstrate higher rates of abnormal results, reinforcing concerns about diagnostic accuracy. Variability in timing of inpatient testing and discordant diagnostic criteria between professional organizations further complicate interpretation.</p> Summary <p>Immediate postpartum OGTT is a pragmatic strategy that substantially improves screening completion and effectively excludes persistent dysglycemia when normal. However, abnormal results—particularly single elevated values—should be interpreted cautiously due to limited specificity in the early postpartum period. Until optimal timing, diagnostic thresholds, and follow-up strategies are better defined, inpatient testing may be best used as an initial screen, with confirmatory testing at 4–12&#xa0;weeks postpartum for abnormal findings and continued long-term metabolic surveillance for all individuals with prior GDM.</p>

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Should Women with Gestational Diabetes Be Screened for Type 2 Diabetes Immediately After Delivery?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月13日

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  • Ingmar N. Bastian,
  • Mark A. Turrentine

摘要

Purpose of the review

To synthesize current evidence on immediate postpartum (delivery hospitalization) oral glucose tolerance testing (OGTT) following gestational diabetes mellitus (GDM), with a focus on underlying physiology, diagnostic performance, implementation outcomes, and evolving diagnostic criteria, in order to clarify its role in postpartum diabetes screening.

Recent findings

Emerging physiologic data demonstrate that insulin sensitivity improves rapidly within days of delivery, supporting the feasibility of early postpartum glucose testing. Observational and prospective studies show that immediate postpartum OGTT has high negative predictive value for overt diabetes, suggesting utility as a rule-out test. However, specificity and positive predictive value are limited, and sensitivity is modest, raising concern for overclassification due to transient metabolic changes. A 2023 meta-analysis reported pooled sensitivity of 81% and specificity of 61% for early testing. In contrast, completion rates are consistently higher with inpatient testing compared with traditional 4–12 week screening. Real-world implementation studies confirm substantial improvements in screening uptake, with completion rates exceeding 70–80%, but also demonstrate higher rates of abnormal results, reinforcing concerns about diagnostic accuracy. Variability in timing of inpatient testing and discordant diagnostic criteria between professional organizations further complicate interpretation.

Summary

Immediate postpartum OGTT is a pragmatic strategy that substantially improves screening completion and effectively excludes persistent dysglycemia when normal. However, abnormal results—particularly single elevated values—should be interpreted cautiously due to limited specificity in the early postpartum period. Until optimal timing, diagnostic thresholds, and follow-up strategies are better defined, inpatient testing may be best used as an initial screen, with confirmatory testing at 4–12 weeks postpartum for abnormal findings and continued long-term metabolic surveillance for all individuals with prior GDM.