Details:

Alternative Title:
Obstet Gynecol
Publisher's site:
http://dx.doi.org/10.1097/AOG.0000000000001467
Personal Author:
Eggleston, Emma Morton ; LeCates, Robert Franklin ; Zhang, Fang ; Wharam, James Franklin ; Ross-Degnan, Dennis ; ... More +
Eggleston, Emma Morton ; LeCates, Robert Franklin ; Zhang, Fang ; Wharam, James Franklin ; Ross-Degnan, Dennis ; Oken, Emily ; Less -
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.
Subject:
[+]
Adult
Article
Blood Glucose
Diabetes, Gestational
Diabetes Mellitus, Type 2
Female
Glucose Intolerance
Glucose Tolerance Test
Health Services Misuse
Hemoglobin A, Glycosylated
Humans
Insurance Claim Review
Massachusetts
Mass Screening
Postnatal Care
Postpartum Period
Pregnancy
Retrospective Studies

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 ;
K24 HD069408/HD/NICHD NIH HHS/United States ; P30 DK092924/DK/NIDDK NIH HHS/United States ; U58 DP002719/DP/NCCDPHP CDC HHS/United States ; Less -
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:e6b7144f34e00380d8bb1a6443046fdb2d3308e190034055bb485990d0bf7a86
File Type:

Supporting Files

• 	NIHMS776740-supplement-Supplemental_Digital_Content.pdf	pdf
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