we conducted a retrospective chart review of 373 postpartum gdm patients seen at a major academic medical center between january 2010 and november 2012 . variables of interest included race / ethnicity , level of formal education , income , age , history of gdm or delivery of a large - for - gestational - age baby , bmi at diagnosis , gestational age at diagnosis , type of treatment received , infant birth weight , pre- and postpartum gtt results , and follow - up at a postpartum visit within 4 months of delivery . means and standard deviations were calculated to summarize continuous variables ; counts and percentages were calculated to summarize categorical variables . the comparisons between groups were performed with the use of kruskal - wallis or wilcoxon rank - sum tests for continuous variables and pearson s  test for categorical variables . a logistic regression model was also fit to assess the association between keeping a follow - up visit appointment and prespecified confounding variables . . sixty percent of patients were identified as caucasian / white , 17% as hispanic / latina , 9% as african - american / black , and 14% as other backgrounds , including asian , middle eastern , and african . the majority of patients received only diet and exercise counseling for treatment ; the next most common form of treatment was insulin therapy , followed by glyburide . demographics ( n = 373 ) descriptive statistics and analysis of variance were used to identify characteristics of patients who did not attend their postpartum follow - up appointment in the endocrinology clinic . patients with less than a high school education were significantly less likely to complete a follow - up visit ( defined as a return to the endocrinology clinic within 4 months of delivery for the purposes of gdm follow - up ) than patients with an advanced degree ( odds ratio [ or ] 4.36 , 95% ci 1.4213.41 ) . furthermore , education level was inversely correlated with fasting glucose at time of diagnosis , which is a significant predictor of postpartum diabetes risk . the or of having a higher fasting glucose for a patient with a high school education versus an advanced degree was 2.77 ( 95% ci 1.097.00 ) . average bmi at diagnosis was 31.7 kg / m among patients who did not follow up and 29.9 kg / m among those who did follow up ( p = 0.01 ) ; patients with a higher bmi were less likely to keep their follow - up visits ( or 0.69 ) . of note , a prepregnancy bmi > 30 kg / m is associated with an increased risk of postpartum diabetes among women with gdm . these data suggest that a lower level of formal education and higher bmi at diagnosis are associated with a decreased likelihood of completing a follow - up visit . incidentally , patients with lower levels of education have higher fasting glucose levels at diagnosis . both higher fasting glucose and higher prepregnancy bmi are linked to greater postpartum diabetes risk , suggesting that gdm patients least likely to follow up are also the patients at the highest risk for postpartum type 2 diabetes . although race / ethnicity was not independently associated with postpartum follow - up , associations between racial / ethnic categories and the observed risk factors existed . average bmi at diagnosis was 33.3 kg / m for hispanic / latina and african - american patients and 31.0 kg / m for caucasian patients ( p < 0.001 ) . nearly 20% of caucasian patients had an advanced degree compared to 12.9% of african - american patients and 1.8% of hispanic / latina patients ( p < 0.001 ) . therefore , hispanic / latina and , to a lesser extent , african - american patients may be more likely to have risk factors for not following up in populations similar to the one in this study . postpartum follow - up for gdm patients is essential to identify and treat those who develop diabetes early in the postpartum period . early diagnosis and treatment serve as secondary prevention of long - term complications associated with diabetes . follow - up is also crucial for establishing or maintaining lifestyle changes that decrease type 2 diabetes risk . this retrospective chart review demonstrated that the patients least likely to follow up were those with lower levels of formal education ( less than a high school degree ) . these patients were at the highest risk of developing postpartum type 2 diabetes given that they also had higher bmis and fasting glucose levels at diagnosis . although race was not independently associated with postpartum follow - up , hispanic / latina and , secondarily , african - american patients had higher bmis and lower levels of education than caucasian patients in this population . other studies have found that african - american and hispanic / latina women with a history of gdm are at higher risk of postpartum type 2 diabetes , which highlights the intersection of demographic and physiological risk factors for both clinical attrition and later morbidity . primary care providers ( pcps ) and obstetricians may play an important role in identifying women at high risk of gdm in the preconception and early prenatal periods . lifestyle changes to encourage weight loss and prevent hyperglycemia in early pregnancy may be particularly important for this population . a systematic review of interventions to increase postpartum testing rates among gdm patients found that proactive programs featuring reminders to both patients and their pcps , as well as patient tracking systems , were the most effective . because women interact with pediatricians frequently during the months after delivery , pediatricians may be another important provider group to engage . just as they administer postpartum depression screenings , pediatricians could administer maternal and child chronic disease risk screenings and recommend appropriate clinical and community resources to promote healthy lifestyles . maternal lifestyle risk factors may directly affect child health ; a study of hispanic / latino families found that parental physical activity was strongly correlated with toddler physical activity . pediatricians may be ideal providers to promote family health , particularly in the first 5 years of a child s life , when maternal risk of conversion to type 2 diabetes after gdm is highest and excessive infant weight gain is particularly deleterious . this study identifies opportunities to target patients with lower levels of formal education , higher fasting glucose levels , and bmis > 30 collaborative clinical efforts to engage this subgroup may be particularly effective in terms of morbidity prevention . one study found that pregnancies complicated by gdm were associated with costs of care 34% greater than for uncomplicated pregnancies ; women with gdm had significantly higher rates of emergency caesarean section , and their infants were more likely to require neonatal intensive care . after delivery , women with gdm face an increased risk of developing diabetes and contributing to the $ 245 billion spent annually on diabetes care in the united states . in a setting of increased health care costs , preventive measures to reduce both perinatal complications and long - term disease morbidity are crucial . our findings demonstrate that minority women , in particular hispanic / latina and african - american patients , are more likely to have higher bmis and lower levels of formal education , factors associated with a higher likelihood of postpartum clinical attrition . decreasing disparities in gdm care , therefore , also involves preventive efforts and advocacy outside the clinical setting . limitations of this study include its descriptive nature and the limited number of cases ( n = 373 ) . with a larger cohort , the racial / ethnic category of  other  could be further stratified into discrete categories , providing more information by race / ethnicity . a prospective study would provide opportunities to explore trends in the development of postpartum type 2 diabetes , perinatal complications , or other sequelae . directions for future research may include exploring barriers to postpartum follow - up among patients who fail to return to the clinic after delivery . such research could inform the development of effective interventions to increase postpartum follow - up rates among patients identified as being at high risk in this population . its potential to affect long - term individual , as well as intergenerational , health calls for expanded research efforts to elucidate persistent gaps and disparities in treatments and outcomes .
in briefpostpartum follow - up for patients with gestational diabetes mellitus ( gdm ) is essential to manage future disease risk . in a diverse , urban population of gdm patients at a major medical center , 
 high fasting glucose , high bmi at diagnosis , and low education level were associated with not following up in the endocrinology clinic after delivery ; patients least likely to follow up are , therefore , also at greatest risk of gdm complications . 
 although race / ethnicity was not a significant predictor of follow - up , hispanic / latina and african - american patients were more likely to have risk factors for postpartum clinical attrition .