Comparison of Postpartum Diabetes Screening Rates in Patients with Gestational Diabetes: Scheduled Clinic Visits vs. Inpatient Screening

Comparison of Postpartum Diabetes Screening Rates in Patients with Gestational Diabetes: Scheduled Clinic Visits vs. Inpatient Screening | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Postpartum Diabetes Screening Rates in Patients with Gestational Diabetes: Scheduled Clinic Visits vs. Inpatient Screening Callista Osley, Emily Carletto, Elizabeth Enright, Vedavalli Govindan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7584255/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Women with gestational diabetes mellitus (GDM) face a high risk of developing type 2 diabetes mellitus (T2DM), yet fewer than half complete recommended postpartum screening. Traditional outpatient testing is limited by barriers such as loss to follow-up, lack of physician orders, and socioeconomic challenges. Inpatient screening during the delivery hospitalization has emerged as a potential strategy to improve completion rates and address disparities. Methods A retrospective review was conducted among women with GDM between the first six months of 2024 (pre-implementation) and the first six months of 2025 (post-implementation). Data was extracted from electronic medical records using Epic’s SlicerDicer. Screening completion was defined as documented postpartum diabetes testing performed during the delivery hospitalization or within 12 weeks postpartum. The primary analysis compared screening completion between years using risk difference (RD), relative risk (RR), odds ratio (OR), and χ² testing. Secondary analyses evaluated screening setting (inpatient vs. outpatient), race-stratified changes, and within-year equity; Fisher’s exact test was used when expected counts < 5. Results Screening completion increased from 46.2% (36/78) to 65.8% (77/117) (RD 19.7%, 95% CI 5.7–33.7; RR 1.43, 95% CI 1.09–1.87; OR 2.25, 95% CI 1.25–4.04; χ²=7.42, p = 0.0064). This shift was driven by inpatient screening, which rose from 5.6% to 84.4% among screened patients (p < 0.0001). Race-stratified analyses demonstrated improvements across all groups, most notably in the Unknown/None group (RD 0.41, 95% CI 0.20–0.62; RR 2.77, 95% CI 1.33–5.76; OR 5.88, 95% CI 1.98–17.48; p < 0.001). Racial disparities present in 2024 (p = 0.015) were no longer statistically significant in 2025 (p = 0.836). Conclusion Implementation of inpatient postpartum diabetes screening in patients with GDM significantly improved overall screening completion and eliminated statistically significant racial disparities. Incorporating inpatient testing into standard postpartum care may reduce barriers to outpatient follow-up and promote earlier detection of persistent glucose intolerance in postpartum patients at risk for developing T2DM. gestational diabetes postpartum care type 2 diabetes inpatient screening health equity Figures Figure 1 Figure 2 Figure 3 Background Gestational diabetes mellitus (GDM) is defined by the American College of Obstetricians and Gynecologists (ACOG) as a carbohydrate intolerance that develops during pregnancy ( 1 ). It is one of the most common pregnancy complications; an estimated 7% of pregnancies are complicated by any type of diabetes in the United States, and approximately 86% of those cases are women with GDM ( 2 ). Past research has shown that there is an increased prevalence of GDM among Hispanic and African American women ( 3 ). The risk of developing GDM correlates with risk factors associated with type 2 diabetes mellitus (T2DM), such as obesity, increased age, and sedentary lifestyle. The prevalence of GDM is rising, paralleling national increases in obesity and delayed childbearing ( 1 ). Prior studies have shown higher rates among Hispanic and Black women compared with White women ( 3 ). Both maternal and fetal complications are associated with a diagnosis of GDM. Women diagnosed with GDM are at a higher risk of developing pre-eclampsia and undergoing a cesarean section ( 4 , 5 ). Additionally, up to 70% of women who are diagnosed with GDM develop T2DM later in life ( 6 ). Fetal complications include macrosomia, neonatal hypoglycemia, hyperbilirubinemia, shoulder dystocia, and birth trauma ( 1 ). There is also a potential risk of stillbirth in the setting of poor glycemic control ( 7 ). Screening methods for GDM first began with a thorough history with the patient. A study in 1973 suggested the 50-g, 1-hour glucose tolerance test (GTT) as a screening tool, which has become widely accepted as standard practice for screening GDM ( 8 ). In 2014, it was advised that all women at or beyond 24 weeks of gestation be screened for GDM ( 9 ). Although GDM typically resolves after delivery, approximately one-third of affected women are found to have persistent diabetes at their postpartum screening ( 1 ). Postpartum screening is therefore critical to identify persistent glucose intolerance and prevent long-term morbidity. Originally, it was recommended that postpartum screening for women with GDM be performed 4 to 12 weeks postpartum with a 2-hour, 75 g oral GTT ( 8 ). It is estimated that less than one-half of women diagnosed with GDM receive postpartum screening. This may be due to barriers to care, such as a lack of physician orders for a GTT, failure of the patient to complete the test, and loss of health insurance ( 10 ). Additionally, factors like low education, lack of awareness of the progression to T2DM, and low health literacy may lead to poor follow-up ( 10 ). Postpartum glucose testing has traditionally been conducted no earlier than 4 weeks post-delivery. Recent studies, however, have evaluated the performance of the 75-g oral GTT administered during the delivery hospitalization compared with the conventional 6-week postpartum test, demonstrating high sensitivity and specificity for the diagnosis of diabetes ( 10 , 11 ). The purpose of this study was to analyze the rates of postpartum screening for gestational diabetes mellitus. Additionally, screening rates in the inpatient setting, the outpatient setting, and instances of no screening were compared between years 2024 and 2025. Emerging evidence supporting inpatient postpartum diabetes screening prompted a comparison between screening performed during a scheduled outpatient postpartum visit and screening conducted inpatient during the same hospital stay in which they delivered their baby. Cape Fear Valley Hospital System’s OB/Gyn Resident Clinic began implementing inpatient postpartum diabetes screening for patients with GDM in October 2024. With this new implementation, this work aimed to compare postpartum diabetes screening rates between the first six months of 2024 to the first six months of 2025. A secondary goal of this paper was to evaluate screening across racial groups. Methods Data Collection This retrospective study included women older than eighteen who delivered live singleton births and were patients at the obstetric and gynecology resident clinic within the Cape Fear Valley Health System. The study periods included January 1, 2024 through June 30, 2024 (pre-implementation) and January 1, 2025 to June 30, 2025 (post-implementation). In October 2024, the health system implemented inpatient postpartum diabetes screening before hospital discharge. For comparison, patients were categorized into two cohorts: 2024 (pre-implementation) and 2025 (post-implementation). Data was extracted from the electronic medical records using the SlicerDicer function in Epic. There were a total of 78 births in 2024 and 117 births in 2025. Demographic characteristics of the population, including race, ethnicity, age, and pregravid body mass index (BMI) were also assessed (Table 1 ). The study population primarily consisted of individuals self-identifying as “Black/African American” or “White” and “Hispanic or not Hispanic” (Table 1 ). Races that did not fall into these categories or with unknown classification were grouped together. Table 1 Patient demographics and total births from 2024 and 2025 study populations are shown. 2024 Patient Demographic 2024 Total Number of Patients 2025 Total Number of Patients Total Births 78 117 Race Black 33 46 White 19 24 Unknown/None of the Above 26 47 Ethnicity Hispanic 18 33 Not Hispanic 56 79 Unknown/None of the Above 4 5 Age 18–34 years old 53 91 35–50 years old 24 26 50 years old or older 1 0 Pregravid BMI 35 34 35 BMI Unknown 12 21 Inclusion criteria required subjects to be patients of the resident obstetrics and gynecology clinic, have a diagnosis of GDM, have no previous diagnosis of T2DM, be 18 years or older, and have a singleton birth. Subjects were excluded from this study if they were not patients in the resident clinic, did not have a diagnosis of GDM, had a previous diagnosis of T2DM, were younger than 18 years old, or had multiple gestations. Ethical Considerations This study was reviewed by the Cape Fear Valley Health System Institutional Review Board (IRB Protocol #1225-25) and determined to be exempt under 45 CFR 46.104(d), Category 4(iii). A waiver of HIPAA authorization was also granted for the entire project. Statistical Analysis The primary outcome was completion of postpartum diabetes screening (yes/no) within the delivery hospitalization or within 12 weeks postpartum. The primary analysis compared screening completion proportions between pre- and post-implementation periods using a two-proportion z-test (equivalent to an uncorrected Pearson χ² test with 1 degree of freedom). Effect sizes included risk difference (RD), relative risk (RR), and odds ratio (OR), each with 95% confidence intervals (CIs). RD CIs were calculated using log-transformed standard errors. Secondary analyses included: ( 1 ) comparing the distribution of screening setting (inpatient, outpatient, none) across years using a χ² test of independence (3×2 table); ( 2 ) among screened patients, comparing the proportion z-test (χ² with 1 df); ( 3 ) race-stratified changes in screening rates between years, with RD, RR, OR, and χ² p-values for each group (Table 3 ; Fig. 3 ); and ( 4 ) within-year equity analyses, comparing screening rates between races using a χ² test of independence (3×2 table). All χ² assumptions were checked. For any 2×2 subgroup with expected cell counts < 5, Fisher’s exact test (two-tailed) was performed instead of χ² (Table 4 ). All analyses were two-sided with α = 0.05 and conducted in Google Sheets (calculations) with verification in Python (SciPy). No adjustments for multiple comparisons were made. Table 3 Race-stratified postpartum diabetes screening changes pre- and post-implementation with RD, RR, OR, and CIs. Race Risk 2024 Risk 2025 RD (95% CI) RR (95% CI) OR (95% CI) χ² p-value Black 0.576 0.652 0.076 (–0.141, 0.294) 1.133 (0.790, 1.625) 1.382 (0.551, 3.464) 0.36 0.55 White 0.579 0.708 0.129 (–0.158, 0.416) 1.224 (0.771, 1.941) 1.766 (0.498, 6.268) 0.83 0.36 Unknown / None of the above 0.231 0.638 0.408 (0.195, 0.620) 2.766 (1.328, 5.763) 5.882 (1.979, 17.482) 14.67 < 0.001 Table 4 Postpartum diabetes screening rates by race in 2024 and 2025, with χ² and Fisher’s tests. Year Race Screened (n) Not Screened (n) % Screened χ² (df = 2) p-value 2024 Black 19 14 57.6 8.36 0.015 2024 White 11 8 57.9 — — 2024 Unknown / None of the above 6 20 23.1 — — 2025 Black 30 16 65.2 0.36 0.836 2025 White 17 7 70.8 — — 2025 Unknown / None of the above 30 17 63.8 — — Results A total of 195 patients met the inclusion criteria: 78 in 2024 (pre-implementation) and 117 in 2025 (post-implementation). Cohort demographics are presented in Table 1 . The majority of patients identified as Black or White; the remainder were categorized as Unknown/None of the above. Screening Completion and Settings Postpartum diabetes screening completion increased from 46.2% (36/78) in 2024 to 65.8% (77/117) in 2025 (RD + 19.7%, 95% CI + 5.7% to + 33.7%; RR 1.43, 95% CI 1.09–1.87; OR 2.25, 95% CI 1.25–4.04; χ²( 1 ) = 7.42, p = 0.0064) (Fig. 1 ). The distribution of screening location shifted significantly following implementation (χ²( 2 ) = 59.98, p < 0.0001) (Table 2 , Fig. 2 ). In 2024, screening occurred primarily in the outpatient setting (34/78, 43.6%), with few inpatient screenings (2/78, 2.6%). By 2025, inpatient screening predominated (65/117, 55.6%), while outpatient screening decreased (12/117, 10.3%). Among screened patients, the proportion screened while inpatient rose from 5.6% in 2024 to 84.4% in 2025 (RD + 0.79; RR 15.19; OR 92.08; χ²( 1 ) = 59.98, p < 0.0001). Table 2 Postpartum diabetes screening distribution in 2024 and 2025: inpatient, outpatient, or not screened. Year Inpatient (n) Outpatient (n) None (n) Total (n) 2024 2 34 42 78 2025 65 12 40 117 Race-Stratified and Equity Analysis Screening rates improved across all racial groups (Table 3 , Fig. 3 ). Among Black patients, screening increased from 57.6% to 65.2% (RD + 0.08, 95% CI − 0.14 to + 0.29; RR 1.13, 95% CI 0.79–1.63; OR 1.38, 95% CI 0.55–3.46; p = 0.49). Among White patients, rates rose from 57.9% to 70.8% (RD + 0.13, 95% CI − 0.16 to + 0.42; RR 1.22, 95% CI 0.77–1.94; OR 1.77, 95% CI 0.50–6.27; p = 0.38). The largest increase occurred in the Unknown/None group, from 23.1% to 63.8% (RD + 0.41, 95% CI + 0.20 to + 0.62; RR 2.77, 95% CI 1.33–5.76; OR 5.88, 95% CI 1.98–17.48; p < 0.001). In 2024, screening rates differed significantly by race (χ²( 2 ) = 8.36, p = 0.015), driven by lower screening among the Unknown/None group. Fisher’s exact p-values were calculated for low-count 2×2 subgroups: Black (p = 0.4962), White (p = 1.0000), Unknown/None (p = 1.0000) (Table 4 ). In 2025, no statistically significant difference was observed between races (χ²( 2 ) = 0.36, p = 0.836). Discussion In this retrospective review, implementing inpatient postpartum diabetes screening for patients with GDM led to a substantial improvement in screening completion within the residency clinic population. Completion rates rose significantly following the change in protocol, with inpatient testing replacing outpatient follow-up as the predominant screening method. These findings add to the growing body of evidence supporting inpatient postpartum diabetes screening for patients with GDM as a feasible and effective strategy to improve postpartum diabetes testing rates. Previous studies have demonstrated that inpatient oral GTT has higher sensitivity and specificity for diagnosing persistent diabetes in the immediate postpartum period, yet application of this approach has been limited ( 10 – 13 ). This study addresses a gap in the literature by providing real-world data from a diverse patient population, demonstrating that a system-level change to incorporate inpatient screening can significantly improve completion rates within a residency clinic setting. An important secondary finding was the elimination of statistically significant racial disparities in screening. In 2024, patients categorized as Unknown/None had markedly lower completion rates, contributing to within-year inequity. By 2025, after implementation of inpatient screening, screening rates improved across all racial groups, and no significant disparities remained. This suggests that inpatient testing may remove structural barriers to follow-up, such as transportation, childcare, insurance coverage, and limited appointment availability; thereby promoting greater equity in postpartum diabetes screening among marginalized populations. Strengths of this study include its focus on a well-defined patient population within a single health system, standardized implementation of the inpatient screening protocol, and objective outcome measurement using electronic medical record data. Additionally, the study population was racially and ethnically diverse, enhancing the generalizability of findings to other residency-based care settings. However, as a single-center retrospective review, the study is limited in that it may not be generalizable to all populations or practice environments. Further, patient-level barriers to outpatient screening were not assessed, limiting the ability to determine whether inpatient screening also mitigated disparities in follow-up care. Furthermore, the inability to randomize patient groups creates the possibility for unmeasured confounders, including patient education, staffing at the time of screenings, or broader healthcare policies, which could have contributed to the observed improvements. Additionally, the study did not assess patient-reported experiences or evaluate whether inpatient screening reduced disparities in follow-up care or improved glycemic control outcomes. As the study was not powered for subgroup analysis, race-stratified results should be interpreted cautiously, especially for smaller groups. Future research should explore whether increased inpatient screening translates into earlier diagnosis, improved management of T2DM, and better long-term health outcomes. Qualitative studies assessing patient and provider perspectives could identify facilitators and barriers to implementation across diverse healthcare settings. Additionally, economic evaluations of inpatient and outpatient screening approaches would be valuable to guide policy and resource allocation. Multi-center trials with larger and more varied populations are warranted to support these findings and potential guideline modifications favoring inpatient postpartum diabetes screening. Conclusion Integrating inpatient postpartum diabetes screening for patients with GDM into standard obstetric care increased overall screening completion and eliminated previously observed racial disparities in our residency clinic population. This improvement was primarily driven by the adoption of testing during the delivery hospitalization. This approach mitigates potential barriers to postpartum follow-up and offers a practical, system-level strategy to improve early detection of persistent glucose intolerance. Broader implementation, supported by evidence on long-term outcomes, patient experience, and cost-effectiveness, could meaningfully enhance care for patients at increased risk of developing T2DM after pregnancy. Abbreviations ACOG: American College of Obstetrics and Gynecology BMI: Body Mass Index CI: Confidence Interval Df: Degrees of Freedom GDM: Gestational Diabetes Mellitus GTT: Glucose Tolerance Test HIPAA: Health Insurance Portability and Accountability Act IRB: Institutional Review Board OB/GYN: Obstetrics and Gynecology OR: Odds Ratio RD: Relative Difference RR: Relative Risk T2DM: Type 2 Diabetes Mellitus χ²: Chi Square Declarations Ethics approval and consent to participate: The study was reviewed and approved by the Cape Fear Valley Health System Institutional Review Board (IRB protocol #1225-25) and determined to be exempt under 45 CFR 46.104(d), Category 4(iii). A waiver of HIPAA authorization was granted. Given the retrospective design, the requirement for informed consent was waived. Consent for publication: Not applicable. This study did not include identifiable individual data. Availability of data and materials: The datasets generated and/or analyzed during the current study are not publicly available due to institutional policies regarding patient confidentiality, but are available from the corresponding author on reasonable request. Competing interests: The authors declare they have no competing interests. Funding: The research received no external funding. Authors Contributions: Callista Osley conceived the study, performed statistical analysis, and assisted in manuscript preparation. Emily Carletto conceived the study, performed data collection, and assisted in manuscript preparation. Elizabeth Enright assisted in manuscript preparation and editing. Vedavalli Govindan assisted in manuscript preparation and editing. David Schutzer conceived the study and helped with study design. All authors read and approved of the final manuscript. Acknowledgements: The authors would like to thank the Cape Fear Valley Health System OB/GYN Residency Program for supporting this project and the patients at Cape Fear Valley. References American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49. doi:10.1097/AOG.0000000000002501 Correa A, Bardenheier B, Elixhauser A, Geiss LS, Gregg E. Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993-2009. Matern Child Health J. 2015;19(3):635-42. doi:10.1007/s10995-014-1553-5 Caughey AB, Cheng YW, Stotland NE, Washington AE, Escobar GJ. Maternal and paternal race/ethnicity are both associated with gestational diabetes. Am J Obstet Gynecol. 2010;202(6):616.e1-5. doi:10.1016/j.ajog.2010.01.082 Yogev Y, Xenakis EMJ, Langer O. The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control. Am J Obstet Gynecol. 2004;191(5):1655-60. doi:10.1016/j.ajog.2004.03.074 Ehrenberg HM, Durnwald CP, Catalano P, Mercer BM. The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol. 2004;191(3):969-74. doi:10.1016/j.ajog.2004.06.057 England LJ, Dietz PM, Njoroge T, et al. Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus. Am J Obstet Gynecol. 2009;200(4):365.e1-8. doi:10.1016/j.ajog.2008.06.031 Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Doss AE, Caughey AB. The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. Am J Obstet Gynecol. 2012;206(4):309.e1-7. doi:10.1016/j.ajog.2012.01.014 Gabbe SG, Gregory RP, Power ML, Williams SB, Schulkin J. Management of diabetes mellitus by obstetrician-gynecologists. Obstet Gynecol. 2004;103(6):1229-34. doi:10.1097/01.AOG.0000128045.50439.89 Moyer VA; U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(6):414-20. doi:10.7326/M13-2905 Waters TP, Kim SY, Werner E, et al. Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes? Am J Obstet Gynecol. 2020;222(1):73.e1-11. doi:10.1016/j.ajog.2019.07.035 Werner EF, Has P, Tarabulsi G, Lee J, Satin A. Early postpartum glucose testing in women with gestational diabetes mellitus. Am J Perinatol. 2016;33(10):966-71. doi:10.1055/s-0036-1583193 Carter EB, Martin S, Temming L, Colditz G, Macones GA, Tuuli MG. Early versus 6–12 week postpartum glucose tolerance testing for women with gestational diabetes. J Perinatol. 2018;38(2):118-21. doi:10.1038/jp.2017.159 Dinglas C, Muscat J, Heo H, Islam S, Vintzileos A. Immediate postpartum glucose tolerance testing in women with gestational diabetes: a pilot study. Am J Perinatol. 2017;34(13):1264-70. doi:10.1055/s-0037-1606620 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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07:32:30","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":66620,"visible":true,"origin":"","legend":"","description":"","filename":"7c2e55b647394e258f442b048907d8421structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7584255/v1/e0cef6b14911b03d5d11081b.xml"},{"id":91958106,"identity":"823f503d-5661-4a41-9946-add92b7f7cc9","added_by":"auto","created_at":"2025-09-23 07:32:30","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":74804,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7584255/v1/50241d8bb3d16d27c7dc685a.html"},{"id":91959838,"identity":"f52daa62-a7d5-4a00-b224-6470ac2e3fb5","added_by":"auto","created_at":"2025-09-23 07:40:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":135486,"visible":true,"origin":"","legend":"\u003cp\u003ePostpartum diabetes screening rates pre- and post-implementation, showing significant decreases between 2024 and 2025.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7584255/v1/5fed8074f7271a4c816617c8.png"},{"id":91958101,"identity":"dcef065d-ce3b-4175-b6fd-d8036959c261","added_by":"auto","created_at":"2025-09-23 07:32:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":146898,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of postpartum diabetes screening methods in 2024 and 2025, showing significant shifts in screening location.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7584255/v1/95ad2cd6c7148ddff5600e15.png"},{"id":91959840,"identity":"1cf582bd-f891-429e-a81e-7bcd506b21c3","added_by":"auto","created_at":"2025-09-23 07:40:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":126312,"visible":true,"origin":"","legend":"\u003cp\u003ePostpartum diabetes screening rates by race in 2024 and 2025, showing changes in racial disparities over time.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7584255/v1/6d4030c85959d05b9f3f038e.png"},{"id":96252312,"identity":"8cd788fb-43df-4391-b20e-d5d07c4e7c99","added_by":"auto","created_at":"2025-11-19 07:40:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1130997,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7584255/v1/4faa05f1-1176-4e78-88e1-b0e9e250482f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Postpartum Diabetes Screening Rates in Patients with Gestational Diabetes: Scheduled Clinic Visits vs. Inpatient Screening","fulltext":[{"header":"Background","content":"\u003cp\u003eGestational diabetes mellitus (GDM) is defined by the American College of Obstetricians and Gynecologists (ACOG) as a carbohydrate intolerance that develops during pregnancy (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It is one of the most common pregnancy complications; an estimated 7% of pregnancies are complicated by any type of diabetes in the United States, and approximately 86% of those cases are women with GDM (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Past research has shown that there is an increased prevalence of GDM among Hispanic and African American women (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The risk of developing GDM correlates with risk factors associated with type 2 diabetes mellitus (T2DM), such as obesity, increased age, and sedentary lifestyle. The prevalence of GDM is rising, paralleling national increases in obesity and delayed childbearing (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Prior studies have shown higher rates among Hispanic and Black women compared with White women (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBoth maternal and fetal complications are associated with a diagnosis of GDM. Women diagnosed with GDM are at a higher risk of developing pre-eclampsia and undergoing a cesarean section (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Additionally, up to 70% of women who are diagnosed with GDM develop T2DM later in life (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Fetal complications include macrosomia, neonatal hypoglycemia, hyperbilirubinemia, shoulder dystocia, and birth trauma (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). There is also a potential risk of stillbirth in the setting of poor glycemic control (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eScreening methods for GDM first began with a thorough history with the patient. A study in 1973 suggested the 50-g, 1-hour glucose tolerance test (GTT) as a screening tool, which has become widely accepted as standard practice for screening GDM (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In 2014, it was advised that all women at or beyond 24 weeks of gestation be screened for GDM (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Although GDM typically resolves after delivery, approximately one-third of affected women are found to have persistent diabetes at their postpartum screening (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Postpartum screening is therefore critical to identify persistent glucose intolerance and prevent long-term morbidity. Originally, it was recommended that postpartum screening for women with GDM be performed 4 to 12 weeks postpartum with a 2-hour, 75 g oral GTT (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIt is estimated that less than one-half of women diagnosed with GDM receive postpartum screening. This may be due to barriers to care, such as a lack of physician orders for a GTT, failure of the patient to complete the test, and loss of health insurance (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Additionally, factors like low education, lack of awareness of the progression to T2DM, and low health literacy may lead to poor follow-up (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Postpartum glucose testing has traditionally been conducted no earlier than 4 weeks post-delivery. Recent studies, however, have evaluated the performance of the 75-g oral GTT administered during the delivery hospitalization compared with the conventional 6-week postpartum test, demonstrating high sensitivity and specificity for the diagnosis of diabetes (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The purpose of this study was to analyze the rates of postpartum screening for gestational diabetes mellitus. Additionally, screening rates in the inpatient setting, the outpatient setting, and instances of no screening were compared between years 2024 and 2025. Emerging evidence supporting inpatient postpartum diabetes screening prompted a comparison between screening performed during a scheduled outpatient postpartum visit and screening conducted inpatient during the same hospital stay in which they delivered their baby. Cape Fear Valley Hospital System\u0026rsquo;s OB/Gyn Resident Clinic began implementing inpatient postpartum diabetes screening for patients with GDM in October 2024. With this new implementation, this work aimed to compare postpartum diabetes screening rates between the first six months of 2024 to the first six months of 2025. A secondary goal of this paper was to evaluate screening across racial groups.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Collection\u003c/h2\u003e\u003cp\u003eThis retrospective study included women older than eighteen who delivered live singleton births and were patients at the obstetric and gynecology resident clinic within the Cape Fear Valley Health System. The study periods included January 1, 2024 through June 30, 2024 (pre-implementation) and January 1, 2025 to June 30, 2025 (post-implementation). In October 2024, the health system implemented inpatient postpartum diabetes screening before hospital discharge. For comparison, patients were categorized into two cohorts: 2024 (pre-implementation) and 2025 (post-implementation).\u003c/p\u003e\u003cp\u003eData was extracted from the electronic medical records using the SlicerDicer function in Epic. There were a total of 78 births in 2024 and 117 births in 2025. Demographic characteristics of the population, including race, ethnicity, age, and pregravid body mass index (BMI) were also assessed (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The study population primarily consisted of individuals self-identifying as \u0026ldquo;Black/African American\u0026rdquo; or \u0026ldquo;White\u0026rdquo; and \u0026ldquo;Hispanic or not Hispanic\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Races that did not fall into these categories or with unknown classification were grouped together.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient demographics and total births from 2024 and 2025 study populations are shown.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024 Patient Demographic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2024 Total Number of Patients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2025 Total Number of Patients\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal Births\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown/None of the Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnicity\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot Hispanic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown/None of the Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;34 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u0026ndash;50 years old\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50 years old or older\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePregravid BMI\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;18.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18.6\u0026ndash;24.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25.0-29.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30.0-34.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI Unknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eInclusion criteria required subjects to be patients of the resident obstetrics and gynecology clinic, have a diagnosis of GDM, have no previous diagnosis of T2DM, be 18 years or older, and have a singleton birth. Subjects were excluded from this study if they were not patients in the resident clinic, did not have a diagnosis of GDM, had a previous diagnosis of T2DM, were younger than 18 years old, or had multiple gestations.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003e This study was reviewed by the Cape Fear Valley Health System Institutional Review Board (IRB Protocol #1225-25) and determined to be exempt under 45 CFR 46.104(d), Category 4(iii). A waiver of HIPAA authorization was also granted for the entire project.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eThe primary outcome was completion of postpartum diabetes screening (yes/no) within the delivery hospitalization or within 12 weeks postpartum. The primary analysis compared screening completion proportions between pre- and post-implementation periods using a two-proportion z-test (equivalent to an uncorrected Pearson χ\u0026sup2; test with 1 degree of freedom). Effect sizes included risk difference (RD), relative risk (RR), and odds ratio (OR), each with 95% confidence intervals (CIs). RD CIs were calculated using log-transformed standard errors.\u003c/p\u003e\u003cp\u003eSecondary analyses included: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) comparing the distribution of screening setting (inpatient, outpatient, none) across years using a χ\u0026sup2; test of independence (3\u0026times;2 table); (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) among screened patients, comparing the proportion z-test (χ\u0026sup2; with 1 df); (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) race-stratified changes in screening rates between years, with RD, RR, OR, and χ\u0026sup2; p-values for each group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e3\u003c/span\u003e); and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) within-year equity analyses, comparing screening rates between races using a χ\u0026sup2; test of independence (3\u0026times;2 table). All χ\u0026sup2; assumptions were checked. For any 2\u0026times;2 subgroup with expected cell counts\u0026thinsp;\u0026lt;\u0026thinsp;5, Fisher\u0026rsquo;s exact test (two-tailed) was performed instead of χ\u0026sup2; (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). All analyses were two-sided with α\u0026thinsp;=\u0026thinsp;0.05 and conducted in Google Sheets (calculations) with verification in Python (SciPy). No adjustments for multiple comparisons were made.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRace-stratified postpartum diabetes screening changes pre- and post-implementation with RD, RR, OR, and CIs.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRisk 2024\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRisk 2025\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRD\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRR\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003cp\u003e(95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eχ\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.652\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.076\u003c/p\u003e\u003cp\u003e(\u0026ndash;0.141, 0.294)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.133\u003c/p\u003e\u003cp\u003e(0.790, 1.625)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.382\u003c/p\u003e\u003cp\u003e(0.551, 3.464)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.579\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.708\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.129\u003c/p\u003e\u003cp\u003e(\u0026ndash;0.158, 0.416)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.224\u003c/p\u003e\u003cp\u003e(0.771, 1.941)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.766\u003c/p\u003e\u003cp\u003e(0.498, 6.268)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnknown / None of the above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.638\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.408\u003c/p\u003e\u003cp\u003e(0.195, 0.620)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.766\u003c/p\u003e\u003cp\u003e(1.328, 5.763)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5.882\u003c/p\u003e\u003cp\u003e(1.979, 17.482)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e14.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostpartum diabetes screening rates by race in 2024 and 2025, with χ\u0026sup2; and Fisher\u0026rsquo;s tests.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eScreened (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot Screened (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e% Screened\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eχ\u0026sup2; (df\u0026thinsp;=\u0026thinsp;2)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e57.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e57.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown / None of the above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e23.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e65.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.836\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e70.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUnknown / None of the above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e63.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 195 patients met the inclusion criteria: 78 in 2024 (pre-implementation) and 117 in 2025 (post-implementation). Cohort demographics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The majority of patients identified as Black or White; the remainder were categorized as Unknown/None of the above.\u003c/p\u003e\n\u003ch3\u003eScreening Completion and Settings\u003c/h3\u003e\n\u003cp\u003ePostpartum diabetes screening completion increased from 46.2% (36/78) in 2024 to 65.8% (77/117) in 2025 (RD\u0026thinsp;+\u0026thinsp;19.7%, 95% CI\u0026thinsp;+\u0026thinsp;5.7% to +\u0026thinsp;33.7%; RR 1.43, 95% CI 1.09\u0026ndash;1.87; OR 2.25, 95% CI 1.25\u0026ndash;4.04; χ\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;7.42, p\u0026thinsp;=\u0026thinsp;0.0064) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe distribution of screening location shifted significantly following implementation (χ\u0026sup2;(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;59.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In 2024, screening occurred primarily in the outpatient setting (34/78, 43.6%), with few inpatient screenings (2/78, 2.6%). By 2025, inpatient screening predominated (65/117, 55.6%), while outpatient screening decreased (12/117, 10.3%). Among screened patients, the proportion screened while inpatient rose from 5.6% in 2024 to 84.4% in 2025 (RD\u0026thinsp;+\u0026thinsp;0.79; RR 15.19; OR 92.08; χ\u0026sup2;(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;59.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePostpartum diabetes screening distribution in 2024 and 2025: inpatient, outpatient, or not screened.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInpatient (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOutpatient (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNone (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal (n)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e78\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e117\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eRace-Stratified and Equity Analysis\u003c/h2\u003e\u003cp\u003eScreening rates improved across all racial groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Among Black patients, screening increased from 57.6% to 65.2% (RD\u0026thinsp;+\u0026thinsp;0.08, 95% CI \u0026minus;\u0026thinsp;0.14 to +\u0026thinsp;0.29; RR 1.13, 95% CI 0.79\u0026ndash;1.63; OR 1.38, 95% CI 0.55\u0026ndash;3.46; p\u0026thinsp;=\u0026thinsp;0.49). Among White patients, rates rose from 57.9% to 70.8% (RD\u0026thinsp;+\u0026thinsp;0.13, 95% CI \u0026minus;\u0026thinsp;0.16 to +\u0026thinsp;0.42; RR 1.22, 95% CI 0.77\u0026ndash;1.94; OR 1.77, 95% CI 0.50\u0026ndash;6.27; p\u0026thinsp;=\u0026thinsp;0.38). The largest increase occurred in the Unknown/None group, from 23.1% to 63.8% (RD\u0026thinsp;+\u0026thinsp;0.41, 95% CI\u0026thinsp;+\u0026thinsp;0.20 to +\u0026thinsp;0.62; RR 2.77, 95% CI 1.33\u0026ndash;5.76; OR 5.88, 95% CI 1.98\u0026ndash;17.48; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003cp\u003eIn 2024, screening rates differed significantly by race (χ\u0026sup2;(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;8.36, p\u0026thinsp;=\u0026thinsp;0.015), driven by lower screening among the Unknown/None group. Fisher\u0026rsquo;s exact p-values were calculated for low-count 2\u0026times;2 subgroups: Black (p\u0026thinsp;=\u0026thinsp;0.4962), White (p\u0026thinsp;=\u0026thinsp;1.0000), Unknown/None (p\u0026thinsp;=\u0026thinsp;1.0000) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In 2025, no statistically significant difference was observed between races (χ\u0026sup2;(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;0.36, p\u0026thinsp;=\u0026thinsp;0.836).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e In this retrospective review, implementing inpatient postpartum diabetes screening for patients with GDM led to a substantial improvement in screening completion within the residency clinic population. Completion rates rose significantly following the change in protocol, with inpatient testing replacing outpatient follow-up as the predominant screening method.\u003c/p\u003e\u003cp\u003eThese findings add to the growing body of evidence supporting inpatient postpartum diabetes screening for patients with GDM as a feasible and effective strategy to improve postpartum diabetes testing rates. Previous studies have demonstrated that inpatient oral GTT has higher sensitivity and specificity for diagnosing persistent diabetes in the immediate postpartum period, yet application of this approach has been limited (\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This study addresses a gap in the literature by providing real-world data from a diverse patient population, demonstrating that a system-level change to incorporate inpatient screening can significantly improve completion rates within a residency clinic setting.\u003c/p\u003e\u003cp\u003eAn important secondary finding was the elimination of statistically significant racial disparities in screening. In 2024, patients categorized as Unknown/None had markedly lower completion rates, contributing to within-year inequity. By 2025, after implementation of inpatient screening, screening rates improved across all racial groups, and no significant disparities remained. This suggests that inpatient testing may remove structural barriers to follow-up, such as transportation, childcare, insurance coverage, and limited appointment availability; thereby promoting greater equity in postpartum diabetes screening among marginalized populations.\u003c/p\u003e\u003cp\u003eStrengths of this study include its focus on a well-defined patient population within a single health system, standardized implementation of the inpatient screening protocol, and objective outcome measurement using electronic medical record data. Additionally, the study population was racially and ethnically diverse, enhancing the generalizability of findings to other residency-based care settings. However, as a single-center retrospective review, the study is limited in that it may not be generalizable to all populations or practice environments. Further, patient-level barriers to outpatient screening were not assessed, limiting the ability to determine whether inpatient screening also mitigated disparities in follow-up care. Furthermore, the inability to randomize patient groups creates the possibility for unmeasured confounders, including patient education, staffing at the time of screenings, or broader healthcare policies, which could have contributed to the observed improvements. Additionally, the study did not assess patient-reported experiences or evaluate whether inpatient screening reduced disparities in follow-up care or improved glycemic control outcomes. As the study was not powered for subgroup analysis, race-stratified results should be interpreted cautiously, especially for smaller groups.\u003c/p\u003e\u003cp\u003eFuture research should explore whether increased inpatient screening translates into earlier diagnosis, improved management of T2DM, and better long-term health outcomes. Qualitative studies assessing patient and provider perspectives could identify facilitators and barriers to implementation across diverse healthcare settings. Additionally, economic evaluations of inpatient and outpatient screening approaches would be valuable to guide policy and resource allocation. Multi-center trials with larger and more varied populations are warranted to support these findings and potential guideline modifications favoring inpatient postpartum diabetes screening.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIntegrating inpatient postpartum diabetes screening for patients with GDM into standard obstetric care increased overall screening completion and eliminated previously observed racial disparities in our residency clinic population. This improvement was primarily driven by the adoption of testing during the delivery hospitalization. This approach mitigates potential barriers to postpartum follow-up and offers a practical, system-level strategy to improve early detection of persistent glucose intolerance. Broader implementation, supported by evidence on long-term outcomes, patient experience, and cost-effectiveness, could meaningfully enhance care for patients at increased risk of developing T2DM after pregnancy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eACOG: American College of Obstetrics and Gynecology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBMI: Body Mass Index\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI: Confidence Interval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDf: Degrees of Freedom\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGDM: Gestational Diabetes Mellitus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGTT: Glucose Tolerance Test\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHIPAA: Health Insurance Portability and Accountability Act\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIRB: Institutional Review Board\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOB/GYN: Obstetrics and Gynecology\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRD: Relative Difference\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRR: Relative Risk\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eT2DM: Type 2 Diabetes Mellitus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026chi;\u0026sup2;: Chi Square\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe study was reviewed and approved by the Cape Fear Valley Health System Institutional Review Board (IRB protocol #1225-25) and determined to be exempt under 45 CFR 46.104(d), Category 4(iii). A waiver of HIPAA authorization was granted. Given the retrospective design, the requirement for informed consent was waived.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eNot applicable. This study did not include identifiable individual data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to institutional policies regarding patient confidentiality, but are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe authors declare they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe research received no external funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors Contributions:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eCallista Osley conceived the study, performed statistical analysis, and assisted in manuscript preparation. Emily Carletto conceived the study, performed data collection, and assisted in manuscript preparation. Elizabeth Enright assisted in manuscript preparation and editing. Vedavalli Govindan assisted in manuscript preparation and editing. David Schutzer conceived the study and helped with study design. All authors read and approved of the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements:\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe authors would like to thank the Cape Fear Valley Health System OB/GYN Residency Program for supporting this project and the patients at Cape Fear Valley. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAmerican College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49. doi:10.1097/AOG.0000000000002501 \u003c/li\u003e\n\u003cli\u003eCorrea A, Bardenheier B, Elixhauser A, Geiss LS, Gregg E. Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993-2009. Matern Child Health J. 2015;19(3):635-42. doi:10.1007/s10995-014-1553-5\u003c/li\u003e\n\u003cli\u003eCaughey AB, Cheng YW, Stotland NE, Washington AE, Escobar GJ. Maternal and paternal race/ethnicity are both associated with gestational diabetes. Am J Obstet Gynecol. 2010;202(6):616.e1-5. doi:10.1016/j.ajog.2010.01.082\u003c/li\u003e\n\u003cli\u003eYogev Y, Xenakis EMJ, Langer O. The association between preeclampsia and the severity of gestational diabetes: the impact of glycemic control. Am J Obstet Gynecol. 2004;191(5):1655-60. doi:10.1016/j.ajog.2004.03.074\u003c/li\u003e\n\u003cli\u003eEhrenberg HM, Durnwald CP, Catalano P, Mercer BM. The influence of obesity and diabetes on the risk of cesarean delivery. Am J Obstet Gynecol. 2004;191(3):969-74. doi:10.1016/j.ajog.2004.06.057\u003c/li\u003e\n\u003cli\u003eEngland LJ, Dietz PM, Njoroge T, et al. Preventing type 2 diabetes: public health implications for women with a history of gestational diabetes mellitus. Am J Obstet Gynecol. 2009;200(4):365.e1-8. doi:10.1016/j.ajog.2008.06.031\u003c/li\u003e\n\u003cli\u003eRosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Doss AE, Caughey AB. The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. Am J Obstet Gynecol. 2012;206(4):309.e1-7. doi:10.1016/j.ajog.2012.01.014 \u003c/li\u003e\n\u003cli\u003eGabbe SG, Gregory RP, Power ML, Williams SB, Schulkin J. Management of diabetes mellitus by obstetrician-gynecologists. Obstet Gynecol. 2004;103(6):1229-34. doi:10.1097/01.AOG.0000128045.50439.89\u003c/li\u003e\n\u003cli\u003eMoyer VA; U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(6):414-20. doi:10.7326/M13-2905 \u003c/li\u003e\n\u003cli\u003eWaters TP, Kim SY, Werner E, et al. Should women with gestational diabetes be screened at delivery hospitalization for type 2 diabetes? Am J Obstet Gynecol. 2020;222(1):73.e1-11. doi:10.1016/j.ajog.2019.07.035\u003c/li\u003e\n\u003cli\u003eWerner EF, Has P, Tarabulsi G, Lee J, Satin A. Early postpartum glucose testing in women with gestational diabetes mellitus. Am J Perinatol. 2016;33(10):966-71. doi:10.1055/s-0036-1583193\u003c/li\u003e\n\u003cli\u003eCarter EB, Martin S, Temming L, Colditz G, Macones GA, Tuuli MG. Early versus 6\u0026ndash;12 week postpartum glucose tolerance testing for women with gestational diabetes. J Perinatol. 2018;38(2):118-21. doi:10.1038/jp.2017.159\u003c/li\u003e\n\u003cli\u003eDinglas C, Muscat J, Heo H, Islam S, Vintzileos A. Immediate postpartum glucose tolerance testing in women with gestational diabetes: a pilot study. Am J Perinatol. 2017;34(13):1264-70. doi:10.1055/s-0037-1606620\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"gestational diabetes, postpartum care, type 2 diabetes, inpatient screening, health equity","lastPublishedDoi":"10.21203/rs.3.rs-7584255/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7584255/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWomen with gestational diabetes mellitus (GDM) face a high risk of developing type 2 diabetes mellitus (T2DM), yet fewer than half complete recommended postpartum screening. Traditional outpatient testing is limited by barriers such as loss to follow-up, lack of physician orders, and socioeconomic challenges. Inpatient screening during the delivery hospitalization has emerged as a potential strategy to improve completion rates and address disparities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective review was conducted among women with GDM between the first six months of 2024 (pre-implementation) and the first six months of 2025 (post-implementation). Data was extracted from electronic medical records using Epic\u0026rsquo;s SlicerDicer. Screening completion was defined as documented postpartum diabetes testing performed during the delivery hospitalization or within 12 weeks postpartum. The primary analysis compared screening completion between years using risk difference (RD), relative risk (RR), odds ratio (OR), and χ\u0026sup2; testing. Secondary analyses evaluated screening setting (inpatient vs. outpatient), race-stratified changes, and within-year equity; Fisher\u0026rsquo;s exact test was used when expected counts\u0026thinsp;\u0026lt;\u0026thinsp;5.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eScreening completion increased from 46.2% (36/78) to 65.8% (77/117) (RD 19.7%, 95% CI 5.7\u0026ndash;33.7; RR 1.43, 95% CI 1.09\u0026ndash;1.87; OR 2.25, 95% CI 1.25\u0026ndash;4.04; χ\u0026sup2;=7.42, p\u0026thinsp;=\u0026thinsp;0.0064). This shift was driven by inpatient screening, which rose from 5.6% to 84.4% among screened patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Race-stratified analyses demonstrated improvements across all groups, most notably in the Unknown/None group (RD 0.41, 95% CI 0.20\u0026ndash;0.62; RR 2.77, 95% CI 1.33\u0026ndash;5.76; OR 5.88, 95% CI 1.98\u0026ndash;17.48; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Racial disparities present in 2024 (p\u0026thinsp;=\u0026thinsp;0.015) were no longer statistically significant in 2025 (p\u0026thinsp;=\u0026thinsp;0.836).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eImplementation of inpatient postpartum diabetes screening in patients with GDM significantly improved overall screening completion and eliminated statistically significant racial disparities. Incorporating inpatient testing into standard postpartum care may reduce barriers to outpatient follow-up and promote earlier detection of persistent glucose intolerance in postpartum patients at risk for developing T2DM.\u003c/p\u003e","manuscriptTitle":"Comparison of Postpartum Diabetes Screening Rates in Patients with Gestational Diabetes: Scheduled Clinic Visits vs. Inpatient Screening","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-23 07:32:25","doi":"10.21203/rs.3.rs-7584255/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f26bdd0-72bf-4c25-b4de-9d7aaa9e4394","owner":[],"postedDate":"September 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-18T10:09:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-23 07:32:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7584255","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7584255","identity":"rs-7584255","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}