7.2.2.0 Post­par­tum Fol­low-‍up

The OGTT is rec­om­mend­ed over A1C at the time of the 4- to 12-week post­par­tum visit be­cause A1C may be per­sis­tently im­pacted (low­ered) by the in­creased red blood cell turnover re­lat­ed to preg­nan­cy or blood loss at de­liv­ery and be­cause the OGTT is more sen­si­tive at detect­ing glu­cose in­tol­er­ance, in­clud­ing both predi­a­betes and di­a­betes. Re­pro­duc­tive-‍aged women with predi­a­betes may de­vel­op type 2 di­a­betes by the time of their next preg­nan­cy and will need pre­con­cep­tion eval­u­a­tion. Be­cause GDM is as­so­ci­at­ed with an in­creased life-‍time ma­ter­nal risk for di­a­betes es­ti­mat­ed at 50–70% after 15–25 years (81,82), women should also be test­ed every 1–3 years there­after if the 4- to 12-week post­par­tum 75-g OGTT is nor­mal, with fre­quen­cy of test­ing de­pend­ing on other risk fac­tors in­clud­ing fam­i­ly his­to­ry, prepreg­nan­cy BMI, and need for in­sulin or oral glu­cose-lowering med­i­ca­tion dur­ing preg­nan­cy. On­go­ing eval­u­a­tion may be per­formed with any rec­om­mend­ed glycemic test (e.g., A1C, fast­ing plas­ma glu­cose, or 75-g OGTT using nonpreg­nant thresh­olds).