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Tsur N, Pollack R, Frankel M, Tsur A. Future diabetes risk can be predicted by the number of abnormal oral glucose tolerance test values during pregnancy. Diabetes Obes Metab 2024; 26:1050-1056. [PMID: 38112029 DOI: 10.1111/dom.15406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/20/2023]
Abstract
AIM To quantify the future risk of type 2 diabetes (T2D) in women with gestational diabetes (GD) based on baseline metabolic characteristics and the number of abnormal values during a 3-hour 100-g oral glucose tolerance test (OGTT). MATERIALS AND METHODS We conducted a population-based retrospective cohort study of 10 023 pregnant women who underwent testing for GD in a large health maintenance organization in Israel using a 100-g OGTT. Glucose values were obtained at four time points, 0, 60, 120 and 180 minutes. RESULTS We identified 9939 women who met the study criteria. Median follow-up was 3.25 (interquartile range 1.5-5.1; maximum 10.1) years. Using women without GD as reference, women with GD were at an increased risk of future T2D (hazard ratio [HR] 5.33 [95% confidence interval {CI} 3.86-7.34]). This risk increased with a greater number of abnormal OGTT values, with the highest risk seen in women with four abnormal values (HR 16.67 [95% CI 7.94-35.01]). In a multivariate model, a higher number of abnormal values, Arab ethnicity, higher body mass index, triglycerides and prepregnancy glucose were significantly associated with increased risk. Future T2D risk was also affected by the type of OGTT abnormality; an abnormal fasting value had the greatest risk, whereas an abnormal 3-hour value had the lowest risk (HR 3.61 [95% CI 2.42-5.38] vs. 1.50 [95% CI 0.93-2.43], respectively). CONCLUSIONS GD is a heterogenous disease, with varying degrees of glucose intolerance and subsequent T2D risk. Targeting interventions to women at the highest risk may help to improve postpartum adherence and effective long-term follow-up strategies.
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Affiliation(s)
- Noa Tsur
- Department of Internal Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
| | - Rena Pollack
- Department of Endocrinology and Metabolism, Hadassah Medical Centre, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Meir Frankel
- Endocrinology Unit, Shaare Zedek Medical Centre, Jerusalem, Israel
- Department of Endocrinology and Metabolism, Clalit Health Services, Jerusalem, Israel
| | - Anat Tsur
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Endocrinology and Metabolism, Clalit Health Services, Jerusalem, Israel
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Lord M. A Matter of the Heart: Why It Is Time to Change How We Talk About Maternal Mortality. Mil Med 2023; 188:168-170. [PMID: 36217781 DOI: 10.1093/milmed/usac301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/16/2022] [Accepted: 09/29/2022] [Indexed: 11/12/2022] Open
Abstract
As the global burden of disease shifts from "diseases of poverty" such as diarrhea to "diseases of affluence" like diabetes and heart disease, a parallel shift is underway in maternal health. Maternal death from hemorrhage is decreasing, while deaths resulting from exacerbation of underlying chronic disease are on the rise.
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Affiliation(s)
- Megan Lord
- Division of Maternal Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI 02905, USA
- Department of Preventive Medicine and Biostatistics, Uniformed Service University of the Health Sciences, Bethesda, MD 02814, USA
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Vanderlaan J, Gatlin T, Shen J. Outcomes of Childbirth Education for Women With Pregnancy Complications. J Perinat Educ 2023; 32:94-103. [PMID: 37415933 PMCID: PMC10321455 DOI: 10.1891/jpe-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
The purpose of this study was to examine associations between pregnancy outcomes and childbirth education, identifying any outcomes moderated by pregnancy complications. This was a secondary analysis of the Pregnancy Risk Assessment Monitoring System, Phase 8 data for four states. Logistic regression models compared outcomes with childbirth education for three subgroups: women with no pregnancy complications, women with gestational diabetes, and women with gestational hypertension. Women with pregnancy complications do not receive the same benefit from attending childbirth education as women with no pregnancy complications. Women with gestational diabetes who attended childbirth education were more likely to have a cesarean birth. The childbirth education curriculum may need to be altered to provide maximum benefits for women with pregnancy complications.
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Affiliation(s)
- Jennifer Vanderlaan
- Correspondence regarding this article should be directed to Jennifer Vanderlaan, PhD, MPH, CNM. E-mail:
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Muacevic A, Adler JR, Gordon B, Sriprasert I, Sacks DA, Martin B, Sequeira P, Lee RH. Postpartum Glucose Tolerance Testing Among Patients With Gestational Diabetes During the Coronavirus Disease 2019 Pandemic. Cureus 2023; 15:e34210. [PMID: 36843799 PMCID: PMC9957679 DOI: 10.7759/cureus.34210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction The impact of the coronavirus disease (COVID-19) COVID-19 pandemic on the care of pregnant patients with gestational diabetes (GDM) is largely unreported. The objective of this study was to compare the completion of postpartum oral glucose tolerance testing (GTT) prior to and during the COVID-19 pandemic among patients with GDM. Methods This was a retrospective review of patients diagnosed with GDM between April 2019 and March 2021. Medical records of patients diagnosed with GDM prior to and during the pandemic were compared. The primary outcome was the difference in the completion of postpartum GTT prior to and during the COVID-19 pandemic. Completion was defined as testing between four weeks to six months postpartum. Secondary objectives were: 1) to compare maternal and neonatal outcomes prior to and during the pandemic among patients with GDM, and 2) to compare pregnancy characteristics and outcomes by compliance with postpartum GTT. Results There were 185 patients included in the study, of whom 83 (44.9%) delivered prior to the pandemic and 102 (55.1%) delivered during the pandemic. There was no difference in completion of postpartum diabetes testing prior, compared to during the pandemic (27.7% vs 33.3%, p=0.47). Postpartum diagnosis of pre-diabetes and type two diabetes mellitus (T2DM) did not differ between groups (p=0.36 and p=1.00, respectively). Patients who completed postpartum testing were less likely to have preeclampsia with severe features compared to patients who did not (OR 0.08, 95% CI 0.01-0.96, p=0.02). Conclusion Completion of postpartum testing for T2DM remained poor prior to and during the COVID-19 pandemic. These findings underscore the need for the adoption of more accessible methods of postpartum testing for T2DM among patients with GDM.
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Kindermann L, Costa LDL, Trapani Júnior A. Prevalence of Screening for Diabetes Mellitus in Patients Previously Diagnosed with Gestational Diabetes: Factors Related to its Performance. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1032-1039. [PMID: 36580948 PMCID: PMC9800064 DOI: 10.1055/s-0042-1757955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine how many patients underwent screening for diabetes mellitus (DM) in the puerperium after a diagnosis of gestational DM (GDM) and which factors were related to its performance. METHODS The present is a prospective cohort study with 175 women with a diagnosis of GDM. Sociodemographic and clinico-obstetric data were collected through a questionnaire and a screening test for DM was requested six weeks postpartum. After ten weeks, the researchers contacted the patients by telephone with questions about the performance of the screening. The categorical variables were expressed as absolute and relative frequencies. The measure of association was the relative risk with a 95% confidence interval (95%CI), and values of p ≤ 0.05 were considered statistically significant and tested through logistic regression. RESULTS The survey was completed by 159 patients, 32 (20.1%) of whom underwent puerperal screening. The mean age of the sample was of 30.7 years, and most patients were white (57.9%), married (56.6%), and had had 8 or more years of schooling (72.3%). About 22.6% of the patients used medications to treat GDM, 30.8% had other comorbidities, and 76.7% attended the postnatal appointment. Attendance at the postpartum appointment, the use of medication, and the presence of comorbidities showed an association with the performance of the oral glucose tolerance test in the puerperium. CONCLUSION The prevalence of screening for DM six weeks postpartum is low in women previously diagnosed with GDM. Patients who attended the postpartum consultation, used medications to treat GDM, and had comorbidities were the most adherent to the puerperal screening. We need strategies to increase the rate of performance of this exam.
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Affiliation(s)
- Lucas Kindermann
- Departament of Gynecology and Obstetrics, Hospital Regional de São José Dr. Homero de Miranda Gomes, São José, SC, Brazil,Address for correspondence Lucas Kindermann Departament of Gynecology and Obstetrics, Hospital Regional de São José Dr. Homero de Miranda GomesSão José, SCBrazil
| | - Leandro de Liz Costa
- Faculdade de Medicina, Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil
| | - Alberto Trapani Júnior
- Departament of Gynecology and Obstetrics, Hospital Regional de São José Dr. Homero de Miranda Gomes, São José, SC, Brazil,Faculdade de Medicina, Universidade do Sul de Santa Catarina, Palhoça, SC, Brazil
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Domingo A, Fogel J, Raffel R, Gesner T, Itzhak P. Implementation of a Postpartum Note Reminder and Factors Associated with Postpartum Glucose Tolerance Screening. South Med J 2022; 115:181-186. [PMID: 35237835 DOI: 10.14423/smj.0000000000001367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Although reminder systems are used to increase provider adherence, we are not aware of any real-time reminder systems for provider adherence to postpartum glucose tolerance testing. We studied whether a reminder in the electronic medical records affects provider ordering of a postpartum glucose tolerance test. We also studied whether any demographic, medical history, prenatal, or delivery variables are associated with patient attendance to a postpartum visit and patient completion of the postpartum glucose tolerance test when ordered. METHODS This was a retrospective study of 246 women diagnosed as having gestational diabetes mellitus who completed prenatal care and delivered at a suburban public safety-net hospital. RESULTS Implementation of the real-time postpartum note reminder system significantly improved provider adherence to postpartum glucose screening recommendations from 58.1% to 75.0% (P = 0.01). Delivery complications were significantly associated with increased odds for postpartum visit attendance (odds ratio [OR] 3.80, 95% confidence interval [CI] 1.63-8.86, P < 0.01). Increased gestational age at first prenatal visit was significantly associated with decreased odds for postpartum visit attendance (OR 0.93, 95% CI 0.87-0.99, P < 0.05). Speaking Spanish was associated with an increased odds for completion of the postpartum glucose tolerance test when ordered (OR 2.88, 95% CI 1.24-6.70, P = 0.01). CONCLUSIONS We recommend that hospital managers include a reminder system in the electronic medical record. Providers should focus counseling on the potential future risks to the mother, in addition to encouraging continued adherence to postpartum care. Providers also should counsel those who present later to prenatal care about the importance of obtaining postpartum glucose tolerance tests.
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Affiliation(s)
- Anna Domingo
- From the Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York
| | - Joshua Fogel
- From the Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York
| | - Ryan Raffel
- From the Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York
| | - Timothy Gesner
- From the Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York
| | - Petr Itzhak
- From the Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, New York
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You H, Hu J, Liu Y, Luo B, Lei A. Risk of type 2 diabetes mellitus after gestational diabetes mellitus: A systematic review & meta-analysis. Indian J Med Res 2021; 154:62-77. [PMID: 34782531 PMCID: PMC8715678 DOI: 10.4103/ijmr.ijmr_852_18] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background &objectives: Women with gestational diabetes are at an increased risk of being diagnosed as type 2 diabetes, but the postpartum screening rate is low. To provide evidence-based data for health providers and promote postpartum screening, this systematic review and meta-analysis was conducted to access the risks of type 2 diabetes mellitus (T2DM) diagnosis after gestational diabetes mellitus (GDM) in different demographic and maternal subgroups. Methods: MEDLINE, Embase and Cochrane Library were searched systematically. Unadjusted relative risks (RRs) and 95 per cent confidence intervals (CIs) were calculated and pooled using a random-effects model. Heterogeneity was assessed with Cochrane’s Q text and by calculating I2 values. Subgroup analyses were conducted to address the disparities of type 2 diabetes conversion after gestational diabetes in different demographic and maternal subgroups. Results: 1809 publications were screened and 39 cohort studies including 2,847,596 women were selected. In these studies, 78,893 women were diagnosed as T2DM at six weeks or later after delivery. The unadjusted RRs of women diagnosed T2DM at six weeks or later after delivery ranged from 1.32 (95% CI, 0.46-3.37) to 47.25 (95% CI, 2.95-758.01) with a pooled unadjusted RR of 8.92 (95% CI, 7.84-10.14). Older women, women with a family history of diabetes, Black and non-Hispanic White women and women living in Europe and South-East Asia had a higher risk of developing T2DM after GDM. Interpretation & conclusionsxs: It is suggested that healthcare providers may focus on older women with GDM and women with GDM and a family history of diabetes. Black and non-Hispanic White women with GDM may receive more attention, and healthcare providers, especially those in Europe and South-East Asia, may pay more attention to preventive measures for postpartum T2DM.
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Affiliation(s)
- Huaxuan You
- Key Laboratory of Birth Defects & Related Diseases of Women & Children, Ministry of Education; Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Juan Hu
- Key Laboratory of Birth Defects & Related Diseases of Women & Children, Ministry of Education; Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ying Liu
- West China Nursing School, Sichuan University, Chengdu, China
| | - Biru Luo
- Key Laboratory of Birth Defects & Related Diseases of Women & Children, Ministry of Education; Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Anjiang Lei
- Key Laboratory of Birth Defects & Related Diseases of Women & Children, Ministry of Education; Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Bounds FL, Rojjanasrirat W, Martin MA. Team-Based Approach to Managing Postpartum Screening of Women with Gestational Diabetes for Type 2 Diabetes. J Midwifery Womens Health 2021; 66:101-107. [PMID: 33599099 DOI: 10.1111/jmwh.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Approximately 6% of pregnant women develop gestational diabetes mellitus (GDM), which is a strong risk factor for developing type 2 diabetes mellitus. It is recommended that women with GDM complete a 75-g oral glucose tolerance test (OGTT) 4 to 12 weeks postpartum to screen for type 2 diabetes. A 3-month retrospective chart review in 2 patient-centered medical homes found that postpartum screening for type 2 diabetes was performed in only 39% of eligible women, despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association. Thus, a quality improvement project was initiated to improve the postpartum type 2 diabetes screening rate. PROCESS This quality improvement project involved an education session that described current ACOG recommendations for diabetes screening. The education session included a pretest and posttest that evaluated participants' understanding about development of type 2 diabetes after GDM. A team-based postpartum guideline designed to enable women to complete a 75-g OGTT at the 4-to-12-week postpartum appointment was implemented. A postintervention chart review was conducted to determine the postintervention rate of type 2 diabetes screening. OUTCOME The mean pretest score for the clinical team was 57%, and the mean posttest score was 99%. Postpartum screening for women with GDM was improved from 39% of women for whom screening was indicated to 77% with the implementation of the team-based guideline. DISCUSSION The quality improvement project results demonstrated that improved understanding of ACOG recommendations combined with the implementation of a team-based guideline significantly improved postpartum screening for type 2 diabetes. Team-based management of care, including education of team members about the rationale for change, may also improve outcomes in other quality improvement projects.
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Affiliation(s)
- Faye L Bounds
- Department of Obstetrics and Gynecology, The Texas Children's Health Plan (TCHP) Center for Children and Women, Houston, Texas
| | | | - Mary A Martin
- Graceland University School of Nursing, Independence, Missouri
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9
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Paul JC, Fitzpatrick JJ. Postpartum glucose screening among women with gestational diabetes. Appl Nurs Res 2020; 56:151341. [PMID: 33280784 DOI: 10.1016/j.apnr.2020.151341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE (1) Determine the rate of completion of glucose screening for diabetes in the postpartum period for women who had gestational diabetes mellitus, and (2) compare the rates of follow up glucose screening among women who had A1GDM or A2GDM 4-12 weeks postoartum. DESIGN A retrospective comparative study. SETTING An academic hospital in an urban community. PARTICIPANTS One hundred and seventy-five women with gestational diabetes who gave birth between January 2012 and September 2015. METHODS The electronic medical record was reviewed to confirm diagnosis of gestational diabetes at 24-28 weeks and completion of 4-12 weeks postpartum glucose screening. All consecutive women meeting eligibility criteria were included. RESULTS The rate of postpartum glucose screening was 38.9%. There were 22 (31.0%) women with A1GDM and 46 (44.2%) women with A2GDM who had postpartum glucose screening (χ2 = 3.12, p = 0.08). CONCLUSIONS The type of GDM, did not affect the rate of follow-up for postpartum glucose screening. Strategies need to be developed to improve postpartum screening rates in women with gestational diabetes.
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Affiliation(s)
- June C Paul
- New York Presbyterian Hospital, 3959 Broadway Avenue, New York, NY 10032, United States of America.
| | - Joyce J Fitzpatrick
- Frances Payne Bolton School of Nursing, Case Western Reserve University Cleveland, OH 44106, United States of America.
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Lorenz A, Oza-Frank R, May S, Conrey EJ, Panchal B, Brill SB, RajanBabu A, Howard K. A quality improvement collaborative increased preventive education and screening rates for women at high-risk for type 2 diabetes mellitus in primary care settings. Prim Care Diabetes 2020; 14:335-342. [PMID: 31706949 DOI: 10.1016/j.pcd.2019.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/19/2019] [Accepted: 09/30/2019] [Indexed: 01/11/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) rates continue to increase across women of reproductive age in the United States. The Ohio Type 2 Diabetes Learning Collaborative aimed to improve education and screening for T2DM among women aged 18-44years at high risk for developing T2DM. METHODS Fifteen primary care practices across Ohio participated in a 12-month quality improvement (QI) collaborative, which included monthly calls to share best practices, one-on-one QI coaching, and Plan-Do-Study-Act cycles. Monthly, practices submitted data on three outcome measures on preventive education and three measures on clinical screening for T2DM. RESULTS Increases across each of the three preventive education rates (range of percent increase: 53.6% - 60.0%) and each of the three screening rates for T2DM (15.0% - 19.4%) were observed. Specifically, screening rates for high-risk women with two or more risk factors for T2DM (excluding gestational diabetes mellitus (GDM)) increased by 16.8% (60.5%-77.3%) while rates for T2DM among women with a history of GDM increased by 15.0% (75.0 - 90.0). CONCLUSIONS A quality improvement collaborative increased preventive education and screening rates for women at high-risk for T2DM in primary care settings.
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Affiliation(s)
- Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States
| | - Reena Oza-Frank
- Ohio Department of Health, 246 N. High Street, Columbus, OH 43215, United States
| | - Sara May
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States.
| | - Elizabeth J Conrey
- Ohio Department of Health, 246 N. High Street, Columbus, OH 43215, United States
| | - Bethany Panchal
- Ohio State University Rardin Family Practice, The Ohio State University Wexner Medical Center, 2231 N. High St., Columbus, OH 43201, United States
| | - Seuli Bose Brill
- Internal Medicine/Pediatrics at Grandview Yard, The Ohio State University Wexner Medical Center, 895 Yard Street, Columbus, OH 43212, United States
| | - Arun RajanBabu
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States
| | - Kristin Howard
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States
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Herrick CJ, Puri R, Rahaman R, Hardi A, Stewart K, Colditz GA. Maternal Race/Ethnicity and Postpartum Diabetes Screening: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2020; 29:609-621. [PMID: 32074479 DOI: 10.1089/jwh.2019.8081] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Introduction: Fifty percent of women with gestational diabetes mellitus (GDM) may progress to type 2 diabetes with highest risk among black women. This study aims to characterize postpartum diabetes screening rates among U.S. women with GDM by racial and ethnic group to characterize potential disparities. Materials and Methods: A standardized search of Ovid-Medline, Embase, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, ProQuest, and Clinicaltrials.gov was conducted through October 12, 2018. Of 1,555 titles reviewed, 27 studies met inclusion criteria. Meta-proportion routines with random-effects models estimated pooled postpartum screening proportion effect size (ES) with 95% confidence interval (CI) by racial and ethnic group. Heterogeneity was measured using Cochrane's Q and Higgins I2 tests. Data were stratified by intervention and data source. Results: There were 96,439 women, of whom 81,930 had race/ethnicity recorded. Heterogeneity was high (I2 = 99.7%). Postpartum screening rates were low (pooled ES 42% [95% CI 35%-48%]). Point estimates for pooled screening proportions were lower among white (pooled ES 35% [95% CI 28%-42%]) and black (pooled ES 33% [95% CI 24%-42%]) women than among Hispanic (pooled ES 45% [95% CI 37%-53%]) and Asian (pooled ES 50% [95% CI 41%-58%]) women. Interventions to improve screening were most common and effective among Hispanic women. Discussion: Postpartum screening for diabetes after GDM remains low, and black women have among the lowest postpartum screening rates despite highest risk for type 2 diabetes progression. Reporting of race/ethnicity, screening methods, and screening time frames varied across studies. Conclusion: Future studies must standardize racial/ethnic data reporting and examine interventions that address postpartum diabetes screening and prevention.
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Affiliation(s)
- Cynthia J Herrick
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Ritika Puri
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Rana Rahaman
- Washington University School of Medicine, Saint Louis, Missouri
| | - Angela Hardi
- Bernard Becker Medical Library, Washington University School of Medicine, Saint Louis, Missouri
| | - Karyn Stewart
- Department of Sociology, DePaul University, College of Liberal Arts and Social Sciences, Chicago, Illinois
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
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Rotem R, Salem-Yaniv S, Sandler-Rahat H, Yohay D, Sade S, Yahav L, Weintraub AY. Adherence to postpartum diabetes mellitus screening, do associated pregnancy complications make a difference? Diabetes Res Clin Pract 2020; 159:107972. [PMID: 31805350 DOI: 10.1016/j.diabres.2019.107972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/16/2019] [Accepted: 11/29/2019] [Indexed: 11/24/2022]
Abstract
AIMS We aimed to investigate the impact of Gestational Diabetes Mellitus (GDM) complications on compliance with postpartum Diabetes screening. METHODS A retrospective cohort study was conducted comparing screening rates of women with and without GDM associated complications who delivered at the Soroka University Medical Center, between 2016 and 2017. The screening test of choice was a 2-hour 75 g oral glucose tolerance test, taken 6-12 weeks after delivery. GDM associated complications included one or more of the following: polyhydramnios, macrosomia, shoulder dystocia or cesarean section. Univariate analysis was used in order to examine if GDM associated complications were associated with postpartum diabetes screening. RESULTS During the study period a 164 women were included, of which, 82 women had suffered from GDM associated complications and comprised the study group and 82 women with GDM but without complications comprised the comparison group. Women in the study group were significantly older with a higher parity order. Induction rates were significantly higher among the comparison group, whereas, cesarean section rates were higher among the study group. No difference was noted with regard to neonatal outcomes. Women in the study group were not found to be more likely to be given screening recommendations at discharge (P = 0.50), at their postpartum visit (P = 0.36) or to perform DM screening postpartum (P = 0.17). CONCLUSION Women with GDM associated complications had a higher rate of compliance to postpartum DM screening recommendations. However, in the current study this difference did not reach statistical significance.
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Affiliation(s)
- Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Medical School of Jerusalem, Jerusalem, Israel.
| | - Simrit Salem-Yaniv
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hadar Sandler-Rahat
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - David Yohay
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shanny Sade
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Yahav
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Adi Y Weintraub
- Department of Obstetrics and Gynecology, Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Du X, Dong Y, Xiao L, Liu GH, Qin W, Yu H. Association between retinol-binding protein 4 concentrations and gestational diabetes mellitus (A1GDM and A2GDM) in different pregnancy and postpartum periods. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:479. [PMID: 31700915 DOI: 10.21037/atm.2019.08.45] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Gestational diabetes mellitus (GDM) can cause severe adverse effects on fetal and neonatal outcomes. The following study investigates the relationship between retinol-binding protein 4 (RBP4) and GDM in pregnant women with different grades (A1 and A2) and different gestational weeks. Methods In this retrospective study, 194 GDM patients (GDM group) and 67 normal glucose tolerance pregnant women (control group) were enrolled from 2014 to 2017. Elbow venous blood samples were collected from all subjects. Enzyme electrode method and enzyme linked immunosorbent assay (ELISA) were used for fasting plasma glucose (FPG) and RBP4/insulin levels (FINS) analysis, respectively. Results At middle pregnancy and late stage, FINS, insulin resistance index (HOMA-IR) and RBP4 were all significantly higher in the GDM group compared to control group (P<0.05). Higher HOMA-IR and RBP4 levels, and lower levels of FPG were observed at late stage than those middle pregnancy in the GDM group (P<0.05). Moreover, FINS and RBP4 gradually decreased from middle pregnancy and late stage after delivery in the GDM group. Levels of FINS and RBP4 in postpartum GDM group were higher than those in normal control group (P<0.05). The optimal cut-off value of RBP4 at middle pregnancy diagnostic GDM was 34.84 µg/mL with sensitivity of 79.4% and specificity of 79.1%. The OGTT0h, 2h in A2GDM group was higher than that in A1GDM group, but there was no difference in OGTT1h, age and FINS, RBP4 in both A1GDM and A2GDM group. Conclusions RBP4 is closely related to GDM, and its levels increases with the increase of gestational weeks, which may reflect the development of insulin resistance in GDM. RBP4 suggests that the impaired insulin function of GDM in pregnant women is still difficult to recover in the short term after delivery. Compared with OGTT1h, the increase in OGTT0h and 2h levels during middle pregnancy is more helpful for predicting the risk of developing A2GDM at late stage.
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Affiliation(s)
- Xiyu Du
- Department of Obstetrics, Shenzhen maternal and child health care hospital affiliated to Southern Medical University, Shenzhen 518000, China
| | - Yunan Dong
- Department of Obstetrics, Shenzhen maternal and child health care hospital affiliated to Southern Medical University, Shenzhen 518000, China
| | - Li Xiao
- Department of Obstetrics, Shenzhen maternal and child health care hospital affiliated to Southern Medical University, Shenzhen 518000, China
| | - Guang-Hui Liu
- Department of Endocrinology, Tongji Hospital affiliated to School of Medicine, Tongji University, Shanghai 200065, China
| | - Wei Qin
- Department of Obstetrics, Shenzhen maternal and child health care hospital affiliated to Southern Medical University, Shenzhen 518000, China
| | - Hong Yu
- Department of Obstetrics, Shenzhen maternal and child health care hospital affiliated to Southern Medical University, Shenzhen 518000, China
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Rodin D, Silow-Carroll S, Cross-Barnet C, Courtot B, Hill I. Strategies to Promote Postpartum Visit Attendance Among Medicaid Participants. J Womens Health (Larchmt) 2019; 28:1246-1253. [PMID: 31259648 DOI: 10.1089/jwh.2018.7568] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Postpartum care is important for promoting maternal and infant health and well-being. Nationally, less than 60% of Medicaid-enrolled women attend their postpartum visit. The Strong Start for Mothers and Newborns II Initiative, an enhanced prenatal care program, intended to improve birth outcomes among Medicaid beneficiaries, enrolled 45,599 women, and included a variety of approaches to increasing engagement in postpartum care. Methods: This study analyzes qualitative case studies that include coded notes from 739 interviews with 1,074 key informants and 133 focus groups with 951 women; 4 years of annual memos capturing activities by each of 27 awardees and 24 Birth Center sites; and a review of interview and survey data from Medicaid officials in 20 states. Results: Strong Start prenatal care included education and support regarding postpartum care and concerns. Key informants identified Strong Start services and other strategies they perceived as increasing access to postpartum care, including provider and/or care coordinator continuity across prenatal, delivery, and postpartum visits; efforts to address information gaps and link women to appropriate resources; enhancing services to meet needs such as treatment for depression; addressing barriers related to transportation and childcare; and aligning incentives to encourage prioritization of postpartum care among patients and providers. They also identified ongoing barriers to postpartum visit attendance. Conclusions: Postpartum care is essential to maternal and infant health. Medicaid enrolls many high-risk women and is the largest payer for postpartum care. Using lessons from Strong Start, providers who serve Medicaid-enrolled women can advance strategies to improve postpartum visit access and attendance.
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Affiliation(s)
- Diana Rodin
- Health Management Associates, New York, New York
| | | | - Caitlin Cross-Barnet
- Research and Rapid-Cycle Evaluation Group, Center for Medicare and Medicaid Innovation (CMMI), Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Brigette Courtot
- Health Policy Center, The Urban Institute, Washington, District of Columbia
| | - Ian Hill
- Health Policy Center, The Urban Institute, Washington, District of Columbia
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15
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Balaji B, Ranjit Mohan A, Rajendra P, Mohan D, Ram U, Viswanathan M. Gestational Diabetes Mellitus Postpartum Follow-Up Testing: Challenges and Solutions. Can J Diabetes 2019; 43:641-646. [PMID: 31230979 DOI: 10.1016/j.jcjd.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/05/2019] [Accepted: 04/30/2019] [Indexed: 12/19/2022]
Abstract
One in every 4 pregnancies is affected by hyperglycemia, of which 90% is gestational diabetes mellitus (GDM). Women with GDM are at a high risk of developing both short- and long-term complications. Various studies have shown the heightened risk of type 2 diabetes among women with GDM. Despite clear evidence from published literature about the substantial risk that GDM imposes on women after delivery, rates of postpartum follow up have been low in most parts of the world. Several reasons, such as lack of awareness among health-care professionals and patient-related barriers, such as emotional stress and adjusting to motherhood, have been cited as reasons for poor follow-up rates. To address these issues and come up with solutions to improve postpartum follow-up rates, it is important to understand these barriers both from the patient and the health-care system points of view. In this review, we have summarized some of the key issues contributing to the low postpartum follow-up rates and have discussed possible strategies to tackle them. Use of proactive reminder systems, such as postal service, telephone call, short messaging service and e-mail, recall registries for GDM and utilization of mobile health technology are some of the key strategies that have been discussed in this review. A brief note on the Women in India with GDM Strategy project, which developed a model of care for GDM in resource-constrained settings and adopted several strategies that led to a 95.8% postpartum follow up, has also been presented.
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Affiliation(s)
| | - Anjana Ranjit Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Pradeepa Rajendra
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Deepa Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Uma Ram
- Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
| | - Mohan Viswanathan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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Herrick CJ, Keller MR, Trolard AM, Cooper BP, Olsen MA, Colditz GA. Postpartum diabetes screening among low income women with gestational diabetes in Missouri 2010-2015. BMC Public Health 2019; 19:148. [PMID: 30717710 PMCID: PMC6360751 DOI: 10.1186/s12889-019-6475-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/24/2019] [Indexed: 11/15/2022] Open
Abstract
Background Gestational diabetes increases risk for type 2 diabetes seven-fold, creating a large public health burden in a young population. In the US, there are no large registries for tracking postpartum diabetes screening among women in under-resourced communities who face challenges with access to care after pregnancy. Existing data from Medicaid claims is limited as women often lose this coverage within months of delivery. In this study, we aim to leverage data from electronic health records and administrative claims to better assess postpartum diabetes screening rates among low income women. Methods A retrospective population of 1078 women with gestational diabetes who delivered between 1/1/2010 and 10/8/2015 was generated by linking electronic health record data from 21 Missouri Federally Qualified Health Centers (FQHCs) with Medicaid administrative claims. Screening rates for diabetes were calculated within 12 weeks and 1 year of delivery. Initial screening after the first postpartum year was also documented. Results Median age in the final population was 28 (IQR 24–33) years with over-representation of black non-Hispanic and urban women. In the final population, 9.7% of women had a recommended diabetes screening test within 12 weeks and 18.9% were screened within 1 year of delivery. An additional 125 women received recommended screening for the first time beyond 1 year postpartum. The percentage of women who had a postpartum visit (83.9%) and any glucose testing (40.6%) in the first year far exceeded the proportion of women with recommended screening tests. Conclusions Linking electronic health record and administrative claims data provides a more complete picture of healthcare follow-up among low income women after gestational diabetes. While screening rates are higher than reported with claims data alone, there are opportunities to improve adherence to screening guidelines in this population. Electronic supplementary material The online version of this article (10.1186/s12889-019-6475-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cynthia J Herrick
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8127, St. Louis, MO, 63110, USA. .,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Matthew R Keller
- Center for Administrative Data Research, Washington University School of Medicine, 4523 Clayton Ave, CB 8051, St. Louis, MO, 63110, USA
| | - Anne M Trolard
- Public Health Data and Training Center, Institute for Public Health, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8217, St. Louis, MO, 63110, USA
| | - Ben P Cooper
- Centene Corporation, 7700 Forsyth Blvd, St. Louis, MO, 63105, USA
| | - Margaret A Olsen
- Center for Administrative Data Research, Washington University School of Medicine, 4523 Clayton Ave, CB 8051, St. Louis, MO, 63110, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
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