Missed Opportunities for Type 2 Diabetes Mellitus Screening Among Women With a History of Gestational Diabetes Mellitus

Kim, Catherine; Tabaei, Bahman P.; Burke, Ray; McEwen, Laura N.; Lash, Robert W.; Johnson, Susan L.; Schwartz, Kendra; Bernstein, Steven J.; Herman, William H.

doi:10.2105/ajph.2005.065722

Cited by 140 publications

(111 citation statements)

References 14 publications

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“…20,[22][23] Yet even women with pregnancy complications often miss their postpartum visits. 22,[24][25][26][27][28] Low-income women-who have disproportionate prevalence of gestational diabetes and hypertensive disorders in pregnancy 4,[29][30] -have multiple barriers to outpatient follow-up in the postpartum period. 31 These barriers include lack of childcare, schedule demands, difficulty accessing care, and lack of understanding about the long-term health risks associated with pregnancy complications 31 and may increase women's reliance on emergency room (ER) settings.…”

Section: In 2008 Inmentioning

confidence: 99%

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

Harris

Chang

Wang

et al. 2015

Journal of Women's Health

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Background: Women with pregnancy complications benefit from closer monitoring postpartum and beyond. Increased postpartum emergency room (ER) use may indicate unmet need for outpatient obstetrics and primary care. The purpose of this study was to evaluate whether women with pregnancy complications (gestational diabetes [GDM], gestational hypertension, and preeclampsia) have increased ER use in the first 6 months postpartum, compared with women without these complications. Methods: We conducted a retrospective population-based cohort study using a 2003-2010 Maryland Medicaid managed care claims data set, linked with U.S. Census data. Data included claims for outpatient and ER visits for women aged 12-45 years who were continuously enrolled in Medicaid for at least 100 days of pregnancy and 90 days postpartum. We used logistic regression to calculate the association between pregnancy complications and having ‡1 ER visit in the 6 months postpartum. Results: We identified 26,074 pregnancies, of which 20% were complicated by GDM, gestational hypertension, or preeclampsia. Of these complicated pregnancies, 42.1% had GDM, 35.4% had gestational hypertension, and 42.5% had preeclampsia (diagnoses were not mutually exclusive). In the 6 months postpartum, 25% of women had ‡1 ER visits. Of the complicated pregnancy group, 27.7% had ‡1 ER visit, versus 23.6% of the comparison group ( p < 0.0001). In adjusted analyses, women with a pregnancy complication were more likely to have ‡1 ER visit compared with women without these complications (odds ratio [OR]1.14, 95% confidence interval [CI] 1.05-1.23). The strength of association was highest in women under age 25 (OR 1.20, 95% CI 1.09-1.33). Preconception medical comorbidities (type 2 diabetes, chronic hypertension, obesity, asthma, mental health, and substance abuse diagnoses) were also strongly associated with postpartum ER use (OR 1.61, 95% CI 1.51-1.73). Conclusions: Pregnancy complications increased ER utilization during the 6 months postpartum, especially among women under age 25 years. Interventions that improve discharge planning and early postpartum care may decrease ER use.

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Section: In 2008 Inmentioning

confidence: 99%

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

Harris

Chang

Wang

et al. 2015

Journal of Women's Health

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“…For example, as the population becomes obese at earlier ages, women with GDM may have a history of more prolonged insulin resistance, rendering risk predictions based on age less accurate. Second, recommended postpartum screening after the index pregnancy needs to increase from its current suboptimal levels (34). Such screening may result in identification of preexisting diabetes; outcomes in subsequent pregnancies affected by frank diabetes may then be improved by preconception care as well as closer monitoring during the pregnancy (35).…”

Section: Other Risk Factorsmentioning

confidence: 99%

Recurrence of Gestational Diabetes Mellitus

2007

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OBJECTIVE -The purpose of this study was to examine rates and factors associated with recurrence of gestational diabetes mellitus (GDM) among women with a history of GDM.RESEARCH DESIGN AND METHODS -We conducted a systematic literature review of articles published between January 1965 and November 2006, in which recurrence rates of GDM among women with a history of GDM were reported. Factors abstracted included recurrence rates, time elapsed between pregnancies, race/ethnicity, diagnostic criteria, and, when available, maternal age, parity, weight or BMI at the initial and subsequent pregnancy, weight gain at the initial or subsequent pregnancy and between pregnancies, insulin use, gestational age at diagnosis, glucose tolerance test levels, baby birth weight and presence of macrosomia, and breast-feeding. RESULTS-Of 45 articles identified, 13 studies were eligible for inclusion. After the index pregnancy, recurrence rates varied between 30 and 84%. Lower rates were found in nonHispanic white (NHW) populations (30 -37%), and higher rates were found in minority populations (52-69%). Exceptions to observed racial/ethnic variations in recurrence were found in cohorts that were composed of a significant proportion of both NHW and minority women or that included women who had subsequent pregnancies within 1 year. No other risk factors were consistently associated with recurrence of GDM across studies. The rates of future preexisting diabetes in pregnancy, socioeconomic status, postpartum diabetes screening rates after the index pregnancy, and the average length of time between pregnancies were generally not reported.CONCLUSIONS -Recurrence of GDM was common and may vary most significantly by NHW versus minority race/ethnicity. Diabetes Care 30:1314 -1319, 2007G estational diabetes mellitus (GDM), or impaired glucose tolerance first diagnosed during pregnancy, affects between 4 and 12% of pregnancies but resolves after pregnancy in ϳ90% of women (1). However, women with a history of GDM have an increased risk for future glucose intolerance, as manifested by maternal diabetes (2) or by recurrent GDM in subsequent pregnancies. As with the index GDM diagnosis, recurrent GDM may reflect preexisting type 2 diabetes that was undiagnosed until pregnancy or a glucose-intolerant state that was amplified by the physiological demands and hormonal changes of pregnancy (3). Rates of recurrence of GDM range widely across reports, and risk factors for recurrence also vary considerably, reflecting variation in screening practices and diagnostic criteria for GDM and underlying risk for glucose intolerance, particularly by race/ ethnicity (4 -16). Rates may also vary with the proportion of women undergoing postpartum diabetes screening after the index pregnancy and subsequent diagnosis of diabetes, as this may distinguish between a subsequent pregnancy labeled as preexisting diabetes instead of GDM. However, the relative importance of these sources of variation is unknown. Therefore, we conducted a systematic review of reports on rates...

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“…[19][20][21][22][23][24][25][26][27][28] However, in Australia, where there is a greater focus on postpartum screening, data indicate that levels are as high as 73%. 29 There is a paucity of data on long-term follow-up; a US study indicated that approximately 40% of females were not tested at all in a 5-year period postpartum.…”

mentioning

confidence: 99%

Diabetes screening after gestational diabetes in England: a quantitative retrospective cohort study

et al. 2013

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Missed Opportunities for Type 2 Diabetes Mellitus Screening Among Women With a History of Gestational Diabetes Mellitus

Abstract: These findings suggest that most women with gestational diabetes mellitus are not screened for type 2 DM after delivery. Opportunities for DM prevention and early treatment are being missed.

Cited by 140 publications

References 14 publications

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis

Recurrence of Gestational Diabetes Mellitus

Diabetes screening after gestational diabetes in England: a quantitative retrospective cohort study

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