Abstract
Objective
Our objective was to describe patient-, provider-, and health systems-level factors
associated with likelihood of obtaining guideline-recommended follow-up to prevent
or mitigate early-onset type 2 diabetes after a birth complicated by gestational diabetes
mellitus (GDM).
Methods
This study presents a retrospective cohort analysis of de-identified demographic and
health care system characteristics, and clinical claims data for 12,622 women with
GDM who were continuously enrolled in a large, national U.S. health plan from January
31, 2006, to September 30, 2012. Data were obtained from the OptumLabs Data Warehouse.
We extracted 1) known predictors of follow-up (age, race, education, comorbidities,
GDM severity); 2) novel factors that had potential as predictors (prepregnancy use
of preventive measures and primary care, delivery hospital size); and 3) outcome variables
(glucose testing within 1 and 3 years and primary care visit within 3 years after
delivery).
Results
Asian ethnicity, higher education, GDM severity, and delivery in a larger hospital
predicted greater likelihood of post-GDM follow-up. Women with a prepregnancy primary
care visit of any type were two to three times more likely to receive postpartum glucose
testing and primary care at 1 year, and 3.5 times more likely to have obtained testing
and primary care at 3 years after delivery.
Conclusions
A history of use of primary care services before a pregnancy complicated by GDM seems
to enhance the likelihood of postdelivery surveillance and preventive care, and thus
reduce the risk of undetected early-onset type 2 diabetes. An emphasis on promoting
early primary care connections for women in their early reproductive years, in addition
to its overall value, is a promising strategy for ensuring follow-up testing and care
for women after complicated pregnancies that forewarn risk for later chronic illness.
Health systems should focus on models of care that connect primary and reproductive/maternity
care before, during, and long after pregnancies occur.
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Biography
Lois McCloskey, MPH, DrPH, Associate Professor and Associate Chair, Community Health Sciences, directs the Center for Excellence in Maternal and Child Health at Boston University. She focuses on disconnects between women's lives and health care systems meant to serve their lifecourse needs.
Biography
Emily Quinn, MA, is an analyst and research manager at the Boston University Biostatistics and Epidemiology Data Analytics Center.
Biography
Omid Ameli, MD, MPH, is a health services researcher at Boston University and a Fellow at OptumLabs Data Warehouse. He is currently working on applications of big data analytics for improving patient and population health.
Biography
Timothy Heeren, PhD, is a Professor of Biostatistics at Boston University School of Public Health. Dr. Heeren's research interests are in applied biostatistics, observational studies, behavioral trials, regression models, and complex survey design.
Biography
Myrita Craig, MS, served as Project Manager at the time the research was conducted and is currently a doctoral student at the Boston University School of Public Health.
Biography
Ronald Iverson, MD, MPH, is Vice Chair of Obstetrics, Director of Labor and Delivery; Assistant Professor of Obstetrics and Gynecology, Boston University School of Medicine.
Biography
Aviva Lee-Parritz, MD, is a maternal-fetal medicine specialist and Chair of the Department of Obstetrics and Gynecology, Boston Medical Center, Boston University School of Medicine. Her field is management of pregestational/gestational diabetes and its impact on maternal and neonatal outcomes.
Biography
Brian Jack, MD, is Professor and past Chair of the Department of Family Medicine at Boston University School of Medicine. His work focuses on development of patient and clinician toolkits and safety measures to improve patient care.
Biography
Judith A. Bernstein, RNC, MSN, PhD, is a Professor of Community Health Sciences, Boston University School of Public Health and Professor of Emergency Medicine, School of Medicine. Her current research activities identify and address gaps in prevention for women and adolescents.
Article info
Publication history
Published online: September 24, 2019
Accepted:
August 5,
2019
Received in revised form:
July 22,
2019
Received:
September 12,
2018
Footnotes
Supported in part by a grant from the National Institutes of Health, United States (NIH RO1 DK107528).
Identification
Copyright
© 2019 Jacobs Institute of Women's Health. Published by Elsevier Inc.
