Chronic Disease| Volume 29, ISSUE 6, P480-488, November 2019

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Interrupting the Pathway from Gestational Diabetes Mellitus to Type 2 Diabetes: The Role of Primary Care

Published:September 24, 2019DOI:



      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).


      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).


      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.


      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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      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.


      Emily Quinn, MA, is an analyst and research manager at the Boston University Biostatistics and Epidemiology Data Analytics Center.


      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.


      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.


      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.


      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.


      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.


      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.


      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.