Physician Care Patterns and Adherence to Postpartum Glucose Testing after Gestational Diabetes Mellitus in Oregon Monica L. Hunsberger 1,2 *, Rebecca J. Donatelle 2 , Karen Lindsay 3 , Kenneth D. Rosenberg 4,5 1 University of Gothenburg, Public Health Epidemiology and Community Medicine, Gothenburg, Sweden, 2 Oregon State University, Department of Public Health, Corvallis, Oregon, United States of America, 3 UCD Department of Obstetrics & Gynaecology, National Maternity Hospital, Holles Street, Dublin 2, Ireland, 4 Oregon Public Health Division, Portland, Oregon, United States of America, 5 Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, United States of America Abstract Objective: This study examines obstetrician/gynecologists and family medicine physicians’ reported care patterns, attitudes and beliefs and predictors of adherence to postpartum testing in women with a history of gestational diabetes mellitus. Research Design and Methods: In November–December 2005, a mailed survey went to a random, cross-sectional sample of 683 Oregon licensed physicians in obstetrician/gynecologists and family medicine from a population of 2171. Results: Routine postpartum glucose tolerance testing by both family physicians (19.3%) and obstetrician/gynecologists physicians (35.3%) was reportedly low among the 285 respondents (42% response rate). Factors associated with high adherence to postpartum testing included physician stated priority (OR 4.39, 95% CI: 1.69–7.94) and physician beliefs about norms or typical testing practices (OR 3.66, 95% CI: 1.65–11.69). Specialty, sex of physician, years of practice, location, type of practice, other attitudes and beliefs were not associated with postpartum glucose tolerance testing. Conclusions: Postpartum glucose tolerance testing following a gestational diabetes mellitus pregnancy was not routinely practiced by responders to this survey. Our findings indicate that physician knowledge, attitudes and beliefs may in part explain suboptimal postpartum testing. Although guidelines for postpartum care are established, some physicians do not prioritize these guidelines in practice and do not believe postpartum testing is the norm among their peers. Citation: Hunsberger ML, Donatelle RJ, Lindsay K, Rosenberg KD (2012) Physician Care Patterns and Adherence to Postpartum Glucose Testing after Gestational iabetes Mellitus in Oregon. PLoS ONE 7(10): e47052. doi:10.1371/journal.pone.0047052 Editor: Philippa Middleton, The University of Adelaide, Australia Received July 6, 2012; Accepted September 7, 2012; Published October 11, 2012 Copyright: ß 2012 Hunsberger et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: These authors have no support or funding to report. Competing Interests: The authors have declared that no competing interests exist. * E-mail: monica.hunsberger@gu.se Introduction Gestational diabetes mellitus (GDM) is an important public health concern as it increases the future risk of developing type 2 diabetes for both mother and child [1]. Defined as impaired glucose tolerance first diagnosed during pregnancy, GDM affects approximately 7% of pregnancies a year in the United States [2]. GDM is the most common metabolic complication of pregnancy and its frequency reflects the frequency of type 2 diabetes the underlying population [3]. A systematic review of GDM patients from 1965–2001 found the cumulative incidence of type 2 diabetes increased markedly in the first 5 years after a GDM pregnancy and appeared to plateau after 10 years [4]. There is evidence that in some populations, women with a history of GDM comprise a substantial proportion of the type 2 diabetes population [5]. In a 2009 meta-analysis, women with previous GDM had 7.5-times the risk of developing type 2 diabetes in the future compared to women with normoglycemic pregnancy [6]. There is evidence that lifestyle modification can prevent or delay the development of type 2 diabetes in high-risk populations [7–9]. Improving care to women with a history of GDM could reduce the incidence of type 2 diabetes since women with a history of GDM comprise a high-risk group, postpartum care and continued follow-up care should be a priority. Therefore, the US National Diabetes Education Program encourages obstetri- cian/gynecologists (Ob/Gyns) and primary care providers to better serve the needs of women with prior gestational diabetes [10]. The puerperium period is frequently referred to as an opportune time for a woman’s physician to encourage health habits and provide medical therapy that ultimately may improve her quality of life [11]. Physicians are uniquely situated to detect diabetes, deliver care, and educate women with a history of GDM during the prodromal period of disease. There are inconsistent recommendations for postpartum testing published by the American Diabetes Association (ADA) [12], the American College of Obstetrics and Gynecologists (ACOG) [13], the American Academy of Family Physicians [14], and the Fifth International Workshop-Conference on Gestational Diabetes Mellitus Panel [15]. The American Diabetes Association recom- mends testing with either fasting plasma glucose (FPG) or an oral PLOS ONE | www.plosone.org 1 October 2012 | Volume 7 | Issue 10 | e47052 D