Variation in Postpartum Glycemic Screening in Women With a History of Gestational Diabetes Mellitus

Details

• Alternative Title:
  Obstet Gynecol
• Personal Author:
  Eggleston, Emma Morton ; LeCates, Robert Franklin ; Zhang, Fang ; Wharam, James Franklin ; Ross-Degnan, Dennis ; Oken, Emily
• Description:
  Objective
  
  To assess patterns and predictors of post-partum diabetes screening in a commercially insured, geographically and sociodemographically diverse sample of women with gestational diabetes (GDM).
  
  Methods
  
  Using commercial insurance claims (2000-2012) from all 50 states, we conducted a retrospective cohort study in 447,556 women with at least one delivery and continuous enrollment one year before and after delivery. We identified women with a GDM pregnancy and examined postpartum diabetes screening type and timing, and performed logistic regression to identify screening predictors.
  
  Results
  
  Gestational diabetes mellitus was diagnosed in 32,253 (7.2%) women during the study timeframe. Three fourths received no screening within 1 year postpartum. Rates of recommended 75-g oral glucose tolerance testing within 6–12 weeks were low but increased over time (27 [2%] in 2001 compared with 249 [7%] in 2011, adjusted odds ratio [OR] 3.1, 95% confidence interval [CI] 2.0–47). Among women screened, those in the Northeast (19%) and South (18%) were least likely to receive a 75-g oral glucose tolerance test within 0–12 weeks (adjusted OR 0.4 for each, CI 0.4–0.5) compared with the West (36%). Asian women were most likely to receive any screening (18%; adjusted OR 1.5, CI 1.3–1.6) compared with white women (12%). Black women were most likely to receive hemoglobin A1c (21%; adjusted OR 2.0, CI 1.3–3.2) compared with white women (11%). Antepartum antiglycemic medication (21%; adjusted OR 2.1, CI 2.0–2.3) or visit to a nutritionist–diabetes educator (19%; adjusted OR 1.6, CI 1.4–1.7) or endocrinologist (23%; adjusted OR 1.7, CI 1.6–1.9) predicted screening within 12 weeks postpartum.
  
  Conclusion
  
  Post-partum diabetes screening remains widely underused among commercially insured women with GDM. Differences in screening by geography, race, and antepartum care can inform health system and public health interventions to increase diabetes detection in this high-risk population.
  
  
• Subjects:
  Adult Blood Glucose Diabetes, Gestational Diabetes Mellitus, Type 2 Female Glucose Intolerance Glucose Tolerance Test Health Services Misuse Hemoglobin A, Glycosylated Humans Insurance Claim Review Mass Screening Postnatal Care Postpartum Period Pregnancy Retrospective Studies

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• Source:
  Obstet Gynecol. 128(1):159-167.
• Pubmed ID:
  27275787
• Pubmed Central ID:
  PMC5049505
• Document Type:
  Journal Article
• Funding:
  K24 HD069408/HD/NICHD NIH HHS/United States ; P30 DK092924/DK/NIDDK NIH HHS/United States ; U58 DP002719/DP/NCCDPHP CDC HHS/United States
• Place as Subject:
  Massachusetts
• Volume:
  128
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e6b7144f34e00380d8bb1a6443046fdb2d3308e190034055bb485990d0bf7a86
• Download URL:
  https://stacks.cdc.gov/view/cdc/42173/cdc_42173_DS1.pdf
• File Type:
  [PDF - 850.22 KB ]