One-Hour Oral Glucose Tolerance Test for the Postpartum Reclassification of Women With Hyperglycemia in Pregnancy.

Summary

In 369 women followed for 5 years postpartum, 1-hour glucose at 3 months best predicted future dysglycemia, outperforming the 2-hour value and identifying additional high-risk women. Adoption of a 1-hour OGTT could improve postpartum reclassification rates after hyperglycemia in pregnancy.

Key Findings

• At 3 months postpartum, 1-hour glucose missed only 10 of 70 dysglycemia cases identified by 2-hour glucose and additionally identified 96 more women.
• Five-year cumulative dysglycemia incidence rose across tertiles of 1-hour glucose (P < 0.0001).
• 1-hour glucose had the largest increase in model concordance (CCI 16.1%) versus 2-hour glucose (14.9%); results were consistent among women with prior GDM.

Clinical Implications

Clinicians can consider a 1-hour 75 g OGTT at ~3 months postpartum to enhance risk stratification and follow-up adherence, potentially informing earlier preventive interventions.

Limitations

• Single-cohort study; external validation across diverse populations and health systems is needed
• The 1-hour threshold optimization and cost-effectiveness were not detailed

Future Directions

Validate 1-hour OGTT thresholds across populations, assess implementation strategies to increase postpartum testing uptake, and model cost-effectiveness versus 2-hour OGTT.