ACOG Committee Opinion No. 729: Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care

Ades, Veronica; Goddard, Brian; Ayala, Savannah Pearson; Bach, Sonya Chemouni; Wu, Stephanie

doi:10.1097/aog.0000000000002660

Cited by 16 publications

(7 citation statements)

References 5 publications

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“…37 38 39 40 Many health disparities are directly related to inequities in social determinants of health and they diminish once these factors are taken into account. 41 42 However, some of the disparities remain secondary to patient-related or health care system–related factors. 43 Possible mechanisms for the association between Hispanic ethnicity and lower rates of insulin prescription for GDM include language barrier and poor health literacy, leading to lower diabetes care utilization.…”

Section: Discussionmentioning

confidence: 99%

Correlates of Insulin Selection as a First-Line Pharmacological Treatment for Gestational Diabetes

et al. 2021

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Objective The aim of this study was to investigate prenatal factors associated with insulin prescription as a first-line pharmacotherapy for gestational diabetes mellitus (GDM; compared with oral antidiabetic medication) after failed medical nutrition therapy. Methods This is a retrospective cohort study of 437 women with a singleton pregnancy and diagnosis of A2GDM (GDM requiring pharmacotherapy), delivering in a university hospital between 2015 and 2019. Maternal sociodemographic and clinical characteristics, as well as GDM-related factors, including provider type that manages GDM, were compared between women who received insulin versus oral antidiabetic medication (metformin or glyburide) as the first-line pharmacotherapy using univariable and multivariable analyses. Results In univariable analysis, maternal age, race and ethnicity, insurance, chronic hypertension, gestational age at GDM diagnosis, glucose level after 50-g glucose loading test, and provider type were associated with insulin prescription. In multivariable analysis, after adjusting for sociodemographic and clinical maternal factors, GDM characteristics and provider type, Hispanic ethnicity (0.26, 95% confidence interval [CI]: 0.09–0.73), and lack of insurance (0.34, 95% CI: 0.13–0.89) remained associated with lower odds of insulin prescription, whereas endocrinology management of GDM (compared with obstetrics and gynecology [OBGYN]) (8.07, 95% CI: 3.27–19.90) remained associated with higher odds of insulin prescription. Conclusion Women of Hispanic ethnicity and women with no insurance were less likely to receive insulin and more likely to receive oral antidiabetic medication for GDM pharmacotherapy, while management by endocrinology was associated with higher odds of insulin prescription.This finding deserves more investigation to understand if differences are due to patient choice or a health disparity in the choice of pharmacologic agent for A2GDM. Key Points

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Section: Discussionmentioning

confidence: 99%

Correlates of Insulin Selection as a First-Line Pharmacological Treatment for Gestational Diabetes

et al. 2021

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“…This scale can be distributed at prenatal intake, along with screening for other social determinants of health as recommended by American College of Obstetricians and Gynecologists (ACOG). 46 Special consideration should be made for individuals who are at greater risk of food insecurity, such as individuals in large households, with greater socioeconomic or neighborhood barriers to obtaining healthy food, or other major social determinants of health. 5,9 Although the impact of food insecurity on diabetes during pregnancy warrants further exploration, screening should be considered to recognize and identify the issue during prenatal care.…”

Section: Clinical Recommendationsmentioning

confidence: 99%

“…To follow up with and monitor patients' access to food, we recommend that clinicians document food insecurity (ICD-10 code Z59.4) in the electronic medical records. 46 While there are no specific guidelines to treat food insecurity during pregnancy, clinicians should be familiar with local and federal resources. 47 Resources will vary by community but may include wellness programs, food exchange, or distribution programs, as well as local diabetes prevention programs.…”

Section: Clinical Recommendationsmentioning

confidence: 99%

Understanding Food Security as a Social Determinant of Diabetes-Related Health during Pregnancy

et al. 2021

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Gestational and pregestational diabetes during pregnancy are substantial and growing public health issues. Low-income individuals and individuals who identify as racial and ethnic minorities are disproportionately affected. Food security, which is defined as the degree to which individuals have capacity to access and obtain food, is at the center of nutritional resources and decisions for individuals with diabetes. While increasingly recognized as an important mediator of health disparities in the United States, food insecurity is understudied during pregnancy and specifically among pregnant individuals with diabetes, for whom the impact of food-related resources may be even greater. Previous research has suggested that food insecurity is associated with type 2 diabetes mellitus diagnoses and disease exacerbation in the general adult population. An emerging body of research has suggested that food insecurity during pregnancy is associated with gestational diabetes mellitus diagnoses and adverse diabetes-related outcomes. Additionally, food insecurity during pregnancy may be associated with adverse maternal and neonatal outcomes. Future research and clinical work should aim to further examine these relationships and subsequently develop evidence-based interventions to improve diabetes-related outcomes among pregnant individuals with food insecurity. The purpose of this article is to offer a working definition of food security, briefly review issues of food insecurity and diabetes, summarize research on food insecurity and diabetes-related pregnancy health, and discuss clinical recommendations and areas for future investigation. Key Points

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“…Patients often feel particularly vulnerable when seeking care in these areas. In the modern era, we prioritize culturally sensitive 1 and trauma-informed care, 2 although this is admittedly a work in progress. We strive to center the patient and provide personalized care based on their values and their experiences.…”

Section: Introductionmentioning

confidence: 99%

What Matters to Whom: Patient and Public Involvement in Research

Gibbins

2022

Clinical Obstetrics &Amp; Gynecology

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We outline a call to action for reproductive health researchers to include patient and public involvement (PPI) in research. PPI prioritizes the patient perspective from study design through dissemination of results which centers the people research intends to serve. PPI highlights the patient as an expert in their own condition. PPI that includes groups harmed by health care disparities can draw attention to these harms and generate novel approaches to address them. Numerous frameworks exist for the use of PPI in research. Because obstetrics and gynecology conditions can be particularly sensitive, PPI is crucial in our field.

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ACOG Committee Opinion No. 729: Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care

Cited by 16 publications

References 5 publications

Correlates of Insulin Selection as a First-Line Pharmacological Treatment for Gestational Diabetes

Correlates of Insulin Selection as a First-Line Pharmacological Treatment for Gestational Diabetes

Understanding Food Security as a Social Determinant of Diabetes-Related Health during Pregnancy

What Matters to Whom: Patient and Public Involvement in Research

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