Postpartum care and contraception provided to women with gestational and preconception diabetes in California's Medicaid program

Abstract

Objectives: To compare rates of postpartum care and contraception provided to women with gestational or preconception diabetes mellitus to women with no known diabetes mellitus. Methods: A retrospective cohort study of 199,860 women aged 15-44 years who were continuously enrolled in California's Medicaid program, Medi-Cal, from 43 days prior to 99 days after delivering in 2012. Claims for postpartum clinic visits and contraceptive supplies were compared for 11,494 mothers with preconception diabetes, 17,970 mothers with gestational diabetes, and 170,396 mothers without diabetes. Multivariable logistic regression was used to control for maternal age, race/ethnicity, primary language, residence in a primary care shortage area, state-funded healthcare program and Cesarean delivery, when examining the effects of diabetes on postpartum care and contraception. Results: Although postpartum clinic visits were more common with diabetes (55% preconception, 55% gestational, 48% no diabetes, p=b.0001), almost half did not receive any postpartum care within 99 days of delivery. Women with pregnancies complicated by diabetes were more likely to receive permanent contraception than women without diabetes (preconception diabetes, aOR: 1.39, 95% CI: 1.31-1.47; gestational diabetes, aOR: 1.20, 95% CI: 1.14-1.27). However, among women without permanent contraception, less than half received any reversible contraception within 99 days of delivery (44% preconception, 43% gestational, 43% no diabetes) and less effective, barrier contraceptives were more commonly provided to women with preconception diabetes than women without diabetes (aOR: 1.24, 95% CI:1.16-1.33). Conclusions: Low-income Californian women with pregnancies complicated by diabetes do not consistently receive postpartum care or contraception that may prevent complication of future pregnancies. Implications: Efforts are needed to improve rates of provision of postpartum care and high quality contraceptive services to low income women in California, particularly following pregnancies complicated by diabetes.

Contraceptive Use Among Women with Prediabetes and Diabetes in a US National Sample

“…More research is needed to understand how women want family planning and preconception care incorporated into diabetes management. Future research should continue to build on the emerging evidence that the postpartum period may be a particularly promising time for innovations in family planning service delivery …”

Usability of encounter data for Medicaid comprehensive managed care vs traditional Medicaid fee‐for‐service claims among pregnant women

“…Then, we required additional continuous enrollment for the measure‐specified time frame to identify the second element (eg, glucose test procedures). We referred to published articles, guidelines, and online medical coding tools to identify relevant diagnosis and procedure codes, as well as medications for specified conditions . An obstetrician on the study team provided feedback to establish face validity of the selected codes and time frames for codependent claims.…”

Interdelivery Interval and Diabetes Mellitus in a Subsequent Pregnancy

“…21 To optimize subsequent pregnancy outcomes, contraception and family planning are key; however, previous research indicates women with pregestational and gestational diabetes may be less likely than women without diabetes to use effective contraception. 22,23 One recent national survey indicated that 20 to 40% of pregnancies following the longest interpregnancy intervals were unintended. 24 Unintended pregnancy among women with a history of gestational diabetes may be particularly important.…”