Obstetricians' and midwives' attitudes and perceived barriers to the implementation of immediate postpartum diabetes testing.

BACKGROUND: Gestational diabetes mellitus (GDM) is increasingly prevalent and is a major risk factor for type 2 diabetes mellitus (DM2). Completion of the conventional 4-12-week postpartum diabetes testing remains low. In May 2024, the American College of Obstetricians and Gynecologists (ACOG) endorsed immediate postpartum diabetes (IPD) testing as an alternative, citing comparable diagnostic performance and higher completion rates. Little is known about the attitudes and practices of obstetricians and midwives regarding IPD testing. The objectives of our study were to assess obstetricians' and midwives' familiarity with IPD testing, willingness to adopt this testing strategy, and the barriers and facilitators to its implementation. METHODS: We conducted a cross-sectional online survey of US-based obstetricians, obstetrical residents, and midwives (September 2024 and July 2025). Respondents who performed IPD testing or did not provide inpatient postpartum care were excluded. Survey items assessed demographics, current testing practices, familiarity, willingness, and implementation barriers and facilitators. Analyses included chi-square, Fisher's exact tests, and t-tests. p values < 0.05 were considered significant. RESULTS: Among the 171 respondents, most were obstetricians (87.1%), predominantly female (93%) and White (57.1%), with a mean age of 41.6 years and 13.7 years in practice across diverse US settings. Willingness to adopt IPD testing was not associated with demographics but was higher among clinicians with prior IPD experience (p = 0.03) and greater familiarity (p = 0.002). Overall, 42.7% were completely unfamiliar with IPD testing, and willingness increased with familiarity (p < 0.05). Key barriers included a lack of familiarity, concerns about patient fasting, perceived lack of ACOG endorsement, and the absence of protocols. Major facilitators were explicit ACOG endorsement, institutional protocols and order sets, and patient education materials. CONCLUSION: Obstetricians and midwives demonstrate a strong willingness to adopt IPD testing; however, implementation may be limited by knowledge gaps and system-level barriers. Education, guideline endorsement, institutional policies, and standardized protocols may improve implementation.