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Bose Brill S, May S, Lorenz AM, Spence D, Prater L, Shellhaas C, Otsubo M, Mao S, Flanigan M, Thung S, Leonard M, Jiang F, Oza-Frank R. Mother-Infant Dyad program in primary care: evidence-based postpartum care following gestational diabetes. J Matern Fetal Neonatal Med 2022; 35:9336-9341. [PMID: 35098857 DOI: 10.1080/14767058.2022.2032633] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM), a common complication of pregnancy, is associated with a 10-fold increased risk of type 2 diabetes mellitus (T2DM) compared to the general population. Evidence-based guidelines recommend that patients with GDM receive postpartum care for T2DM risk reduction including an oral glucose tolerance test (OGTT) 4-12 weeks after delivery, yet half of patients with GDM did not return for their postpartum visits by 12 weeks postpartum. Additionally, only 10% utilize primary care within 12 months of delivery and one-third of GDM patients receive timely postpartum OGTT. OBJECTIVE To determine if the Mother-Infant Dyad postpartum primary care program provides a framework to link well-child visits with postpartum primary care visits to increase postpartum clinical interactions promoting longitudinal care, such as postpartum visit attendance and T2DM screening. STUDY DESIGN All patients with a diagnosis of GDM that received care at a postpartum mother-infant dyad program at a Midwestern academic medical center internal medicine and pediatrics primary care clinic were enrolled. Clinic level data was obtained by baseline and 6-month post-enrollment surveys and chart review. A comparison population was identified from Medicaid claims data using propensity score matching to enable a comparison of program participants' outcomes to a population comprised of similar individuals diagnosed with GDM that received care at sites not participating in the Dyad program. Our primary outcome was completion of T2DM screening in the 4-12 week postpartum period. The secondary outcomes were postpartum visit attendance with a prenatal provider, and prediabetes diagnoses. RESULTS A total of 75 mother-infant dyads were seen by the clinic. Of the enrolled women, 43% were Non-Hispanic White and 30% were Non-Hispanic Black; mean age was 30.75 years. The matched comparison group (n = 62) had a mean age of 30.75 years, were 43% Non-Hispanic White and 30% Non-Hispanic Black. Women who participated in the program were more likely to receive T2DM screenings than women who did not participate (87 vs. 79%, p<.001) and complete postpartum visits (95 vs. 58%, respectively; p<.001). Additionally, a higher rate of new prediabetes diagnoses was observed (12 vs. 6%, p < .001). CONCLUSION The Mother-Infant Dyad postpartum primary care program improved T2DM screenings and postpartum visit attendance. In addition, a greater proportion of Dyad program participants experienced new prediabetes diagnoses that those in the comparison group. Our findings suggest that the dyad care model, in which women with GDM engage in postpartum primary care concurrent with well-child visits, can improve longitudinal postpartum care after a GDM diagnosis.
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Affiliation(s)
- Seuli Bose Brill
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sara May
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH, USA
| | - Allison M Lorenz
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH, USA
| | - Douglas Spence
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH, USA
| | - Laura Prater
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Cynthia Shellhaas
- The Ohio State University Wexner Medical Center, Columbus, OH, USA.,Ohio Department of Health, Columbus, OH, USA
| | - Masami Otsubo
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Shengyi Mao
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew Flanigan
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Stephen Thung
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Melissa Leonard
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH, USA
| | - Fei Jiang
- Ohio Colleges of Medicine Government Resource Center, Columbus, OH, USA
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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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Wang D, Ding W, Xu S, Chen H, Liu B, Wang Z. The relationship between total cholesterol and postpartum impaired glucose tolerance in women with gestational diabetes mellitus. Lipids Health Dis 2020; 19:142. [PMID: 32552849 PMCID: PMC7302143 DOI: 10.1186/s12944-020-01316-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 06/10/2020] [Indexed: 01/23/2023] Open
Abstract
Background History of gestational diabetes mellitus (GDM) and serum lipid abnormalities were associated with postpartum impaired glucose tolerance. To investigate the association between concentration of total cholesterol (TC), at the time of GDM diagnosis, and risk of postpartum glucose intolerance. Methods Women who were diagnosed GDM with a live singleton delivery between January 1, 2013 and December 31, 2017 were included. Women were grouped based on the TC quartiles at the time of GDM diagnosis and had an OGTT at 6–12 weeks after delivery. The relationship between TC and the risk of postpartum glucose intolerance was assessed by COX regression. Results A total of 845 women were in the final analysis. Higher TC quartile at diagnosis of GDM was associated with a decreased risk of postpartum glucose intolerance. Women in the highest TC quartile (>7.0 mmol L− 1) had approximately only half-risk of any postpartum glucose intolerance, compared with women in the lowest TC quartile (<5.5 mmol L− 1). Conclusions The decreased concentration of TC, at the time of GDM diagnosis, was related to an increased risk of postpartum abnormal glucose regulation in GDM women. Therefore, because both excessively increased and decreased TC were associated with pregnancy and postpartum complications, the optimal concentration of maternal TC throughout pregnancy remained to be further researched.
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Affiliation(s)
- Dongyu Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, 58th, Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Wenjing Ding
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, 58th, Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Shuqia Xu
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Sun Yat-sen University, 58th, Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Haitian Chen
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, 58th, Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Bin Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, 58th, Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Sun Yat-sen University, 58th, Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
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Oza-Frank R, Conrey E, Bouchard J, Shellhaas C, Weber MB. Healthcare Experiences of Low-Income Women with Prior Gestational Diabetes. Matern Child Health J 2018; 22:1059-1066. [DOI: 10.1007/s10995-018-2489-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Shellhaas C, Conrey E, Crane D, Lorenz A, Wapner A, Oza-Frank R, Bouchard J. The Ohio Gestational Diabetes Postpartum Care Learning Collaborative: Development of a Quality Improvement Initiative to Improve Systems of Care for Women. Matern Child Health J 2016; 20:71-80. [PMID: 27502198 PMCID: PMC6697553 DOI: 10.1007/s10995-016-2170-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives To improve clinical practice and increase postpartum visit Type 2 diabetes mellitus (T2DM) screening rates in women with a history of gestational diabetes mellitus (GDM). Methods We recruited clinical sites with at least half of pregnant patients enrolled in Medicaid to participate in an 18-month quality improvement (QI) project. To support clinical practice changes, we developed provider and patient toolkits with educational and clinical practice resources. Clinical subject-matter experts facilitated a learning network to train sites and promote discussion and learning among sites. Sites submitted data from patient chart reviews monthly for key measures that we used to provide rapid-cycle feedback. Providers were surveyed at completion regarding toolkit usefulness and satisfaction. Results Of fifteen practices recruited, twelve remained actively engaged. We disseminated more than 70 provider and 2345 patient toolkits. Documented delivery of patient education improved for timely GDM prenatal screening, reduction of future T2DM risk, smoking cessation, and family planning. Sites reported toolkits were useful and easy to use. Of women for whom postpartum data were available, 67 % had a documented postpartum visit and 33 % had a postpartum T2DM screen. Lack of information sharing between prenatal and postpartum care providers was are barriers to provision and documentation of care. Conclusions for Practice QI and toolkit resources may improve the quality of prenatal education. However, postpartum care did not reach optimal levels. Future work should focus on strategies to support coordination of care between obstetrical and primary care providers.
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Affiliation(s)
- Cynthia Shellhaas
- The Ohio Department of Health, 246 N. High Street, Columbus, OH, 43215, USA.
- The Ohio State University College of Medicine, Columbus, OH, USA.
| | - Elizabeth Conrey
- The Ohio Department of Health, 246 N. High Street, Columbus, OH, 43215, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dushka Crane
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH, 43210, USA
| | - Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH, 43210, USA
| | - Andrew Wapner
- The Ohio Department of Health, 246 N. High Street, Columbus, OH, 43215, USA
| | - Reena Oza-Frank
- The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Perinatal Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Jo Bouchard
- The Ohio Department of Health, 246 N. High Street, Columbus, OH, 43215, USA
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