Jan. 19, 2023, 2:58 p.m. News Staff — Two updated clinical recommendations on diabetes screening from the Women’s Preventive Services Initiative, a longtime AAFP partner, recently received approval from the Health Resources and Services Administration.
The recommendations on screening for diabetes during and after pregnancy will take effect for most health insurance plan years beginning in 2024.
Regarding screening for diabetes in pregnancy, the WPSI recommends screening pregnant women for gestational diabetes after 24 weeks of gestation (preferably between 24 and 28 weeks) to prevent adverse birth outcomes. The recommendation also calls for screening pregnant women who have risk factors for type 2 diabetes or gestational diabetes earlier (ideally at the first prenatal visit). These recommendations are consistent with the initiative’s 2016 recommendation on the topic.
For screening after 24 weeks’ gestation, the recommendation calls for either the 50-gram glucose challenge test (followed by a three-hour 100-gram oral glucose tolerance test if results from the initial test are abnormal) or a two-hour 75-gram oral glucose tolerance test.
Similar updates apply to screening for diabetes after pregnancy. The WPSI recommends screening for type 2 diabetes in women with a history of gestational diabetes who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. Initial testing should ideally occur within the first year postpartum and can be performed as early as four to six weeks postpartum.
Women who were not screened in the first year postpartum or who initially had a negative postpartum screening test result should be screened at least every three years for a minimum of 10 years after pregnancy. For those with a positive screening test result in the early postpartum period, testing should be repeated at least six months postpartum to confirm a diagnosis of diabetes. Repeat testing is also indicated for women who were screened using a hemoglobin A1c test in the first six months postpartum, regardless of the result, as the A1c test has been found to be less accurate during that time.
In addition to followup screening for women with a history of gestational diabetes, the WPSI recommends that clinicians follow general diabetes screening recommendations from the U.S. Preventive Services Task Force and the American Diabetes Association.
Corey Lyon, D.O., chair of the AAFP Commission on Health of the Public and Science and an associate professor in the Department of Family Medicine at the University of Colorado Anschutz Medical Campus, Denver, explained how family physicians can play a crucial role in screening during and after pregnancy.
“Patients with a history of gestational diabetes are at an increased risk of developing diabetes, and this risk may persist for up to 10 years,” said Lyon, “so even though the recommendation is to screen within the first year of delivery, family physicians will be the ones providing primary care to these patients and are key to assuring their patients are appropriately rescreened (or initially screened if not previously screened and diagnosed early) to prevent any complications associated with diabetes.”
Lyon also drew comparisons between the WPSI recommendations and the Academy’s clinical preventive service recommendation on screening adults for diabetes. The AAFP supports the USPSTF recommendation for screening for gestational diabetes in asymptomatic pregnant patients at 24 weeks’ gestation or after, as well as its finding that there is insufficient evidence to assess the balance and harms of this screening before 24 weeks’ gestation, which varies slightly from the WPSI recommendation.
Lyon noted that the WPSI recommendation “calls out the increased risk patients diagnosed with gestational diabetes have with developing diabetes.”
“The AAFP and USPSTF found insufficient evidence to screen for gestational diabetes in asymptomatic patients at less than 24 weeks, and the WPSI recommendation does recommend screening prior to 24 weeks (ideally at the first prenatal visit) if risk factors are present,” Lyon said, “so this is a good opportunity for shared decision-making with your pregnant patients.”
Finally, Lyon stressed that it’s important women can keep receiving screenings and other preventive services after pregnancy — care that family physicians can readily provide.
“I think it is important to highlight that once patients are no longer pregnant, it is important that they have access to and receive complete primary care to ensure they receive all of the appropriate screening and chronic disease management, which is more than their OB provider is able to provide,” Lyon said.
Members of the WPSI Advisory Panel will discuss the initiative, including recommendation development and implementation, in a 90-minute webinar at 3 p.m. ET on Jan. 24.