Comparison of Postpartum Diabetes Screening Rates in Patients with Gestational Diabetes: Scheduled Clinic Visits vs. Inpatient Screening

Background Women with gestational diabetes mellitus (GDM) face a high risk of developing type 2 diabetes mellitus (T2DM), yet fewer than half complete recommended postpartum screening. Traditional outpatient testing is limited by barriers such as loss to follow-up, lack of physician orders, and socioeconomic challenges. Inpatient screening during the delivery hospitalization has emerged as a potential strategy to improve completion rates and address disparities. Methods A retrospective review was conducted among women with GDM between the first six months of 2024 (pre-implementation) and the first six months of 2025 (post-implementation). Data was extracted from electronic medical records using Epic’s SlicerDicer. Screening completion was defined as documented postpartum diabetes testing performed during the delivery hospitalization or within 12 weeks postpartum. The primary analysis compared screening completion between years using risk difference (RD), relative risk (RR), odds ratio (OR), and χ² testing. Secondary analyses evaluated screening setting (inpatient vs. outpatient), race-stratified changes, and within-year equity; Fisher’s exact test was used when expected counts < 5. Results Screening completion increased from 46.2% (36/78) to 65.8% (77/117) (RD 19.7%, 95% CI 5.7–33.7; RR 1.43, 95% CI 1.09–1.87; OR 2.25, 95% CI 1.25–4.04; χ²=7.42, p = 0.0064). This shift was driven by inpatient screening, which rose from 5.6% to 84.4% among screened patients (p < 0.0001). Race-stratified analyses demonstrated improvements across all groups, most notably in the Unknown/None group (RD 0.41, 95% CI 0.20–0.62; RR 2.77, 95% CI 1.33–5.76; OR 5.88, 95% CI 1.98–17.48; p < 0.001). Racial disparities present in 2024 (p = 0.015) were no longer statistically significant in 2025 (p = 0.836). Conclusion Implementation of inpatient postpartum diabetes screening in patients with GDM significantly improved overall screening completion and eliminated statistically significant racial disparities. Incorporating inpatient testing into standard postpartum care may reduce barriers to outpatient follow-up and promote earlier detection of persistent glucose intolerance in postpartum patients at risk for developing T2DM.