(CSEMP080) PATTERNS AND RESULTS OF DYSGLYCEMIA SCREENING FOLLOWING A HYPERTENSIVE DISORDER OF PREGNANCY

Abstract: Background
The relationship between dysglycemia and the hypertensive disorders of pregnancy (HDP) (i.e., gestational hypertension, preeclampsia, and eclampsia) is multifaceted. Women with pre-pregnancy dysglycemia or gestational diabetes have an increased risk of HDP. Further, those with HDP have 2 times higher risk of developing dysglycemias (type 2 diabetes, impaired fasting glucose and/or impaired glucose tolerance) within 10 years after delivery. At present, no Canadian guideline provides clear recommendations on screening for dysglycemia in this high-risk population after HDP. The objective of this study was to describe patterns and results of dysglycemia screening for women after HDP compared to normotensive pregnancies over a 10-year period as a foundational step towards a provincial postpartum cardiometabolic disease prevention pathway.
Methods
The Discharge Abstract Database (DAD) was used to identify singleton liveborn deliveries between 2010-2020 (N=491,850). The first delivery for each participant was included and those with pre-pregnancy diabetes, cardiovascular or kidney disease were excluded resulting in 314,022 participants (291,558 without HDP and 22,464 with any HDP using ICD-10CA codes). The DAD was linked to a provincial lab database. Descriptive statistics were used to summarize testing and chi-square tests were used for comparisons between groups. P-value < 0.05 was considered significant.
Results
Screening Patterns: Each year from delivery to 8 years post-partum, the proportion of participants screened for dysglycemia was significantly higher in people with HDP, whereas after 8 years the proportion screened was higher in those without HDP (p < 0.05). A1c was the most used screening test in both groups followed by fasting glucose, and lastly 2-hour OGTT.
Dysglycemia: Mean A1c (mmol/L) was higher in HDP versus non-HDP and trended upwards annually for both groups over a mean 5.66 years (standard deviation [SD] 2.88 years) of follow-up to 5.7% (SD 1.1) in HDP and 5.3% (SD 0.75) in non-HDP at 10 years (p < 0.05). Based upon A1c levels, 2.7% (n=614) of those with HDP compared with 1.2% (n=3574) without HDP (p < 0.001) were classified with diabetes (A1c >6.5%); and 4.5% (n=1012) with HDP versus 2.9% (n=8507) (p < 0.001) without HDP were classified with pre-diabetes (A1c 6.0-6.4%).
Conclusions
Current clinical practice in our province demonstrates that compared with normotensive pregnancies, women with HDP have more laboratory screening tests for dysglycemia and a higher incidence of dysglycemia up to 10 years post-partum. A1c was the most used screening test. Next steps include determining optimal glycemic screening test, timing, and cut-offs to inform screening strategies for women after HDP.