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

Publication ,  Journal Article
Eggleston, EM; LeCates, RF; Zhang, F; Wharam, JF; Ross-Degnan, D; Oken, E
Published in: Obstet Gynecol
July 2016

OBJECTIVE: To assess patterns and predictors of postpartum diabetes screening in a commercially insured, geographically and sociodemographically diverse sample of women with gestational diabetes mellitus. 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 1 year before and after delivery. We identified women with a gestational diabetes mellitus 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: Postpartum diabetes screening remains widely underused among commercially insured women with gestational diabetes mellitus. 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.

Duke Scholars

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Published In

Obstet Gynecol

DOI

EISSN

1873-233X

Publication Date

July 2016

Volume

128

Issue

1

Start / End Page

159 / 167

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Pregnancy
  • Postpartum Period
  • Postnatal Care
  • Obstetrics & Reproductive Medicine
  • Massachusetts
  • Mass Screening
  • Insurance Claim Review
  • Humans
  • Health Services Misuse
 

Citation

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Chicago
ICMJE
MLA
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Eggleston, E. M., LeCates, R. F., Zhang, F., Wharam, J. F., Ross-Degnan, D., & Oken, E. (2016). Variation in Postpartum Glycemic Screening in Women With a History of Gestational Diabetes Mellitus. Obstet Gynecol, 128(1), 159–167. https://doi.org/10.1097/AOG.0000000000001467
Eggleston, Emma Morton, Robert Franklin LeCates, Fang Zhang, James Franklin Wharam, Dennis Ross-Degnan, and Emily Oken. “Variation in Postpartum Glycemic Screening in Women With a History of Gestational Diabetes Mellitus.Obstet Gynecol 128, no. 1 (July 2016): 159–67. https://doi.org/10.1097/AOG.0000000000001467.
Eggleston EM, LeCates RF, Zhang F, Wharam JF, Ross-Degnan D, Oken E. Variation in Postpartum Glycemic Screening in Women With a History of Gestational Diabetes Mellitus. Obstet Gynecol. 2016 Jul;128(1):159–67.
Eggleston, Emma Morton, et al. “Variation in Postpartum Glycemic Screening in Women With a History of Gestational Diabetes Mellitus.Obstet Gynecol, vol. 128, no. 1, July 2016, pp. 159–67. Pubmed, doi:10.1097/AOG.0000000000001467.
Eggleston EM, LeCates RF, Zhang F, Wharam JF, Ross-Degnan D, Oken E. Variation in Postpartum Glycemic Screening in Women With a History of Gestational Diabetes Mellitus. Obstet Gynecol. 2016 Jul;128(1):159–167.

Published In

Obstet Gynecol

DOI

EISSN

1873-233X

Publication Date

July 2016

Volume

128

Issue

1

Start / End Page

159 / 167

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Pregnancy
  • Postpartum Period
  • Postnatal Care
  • Obstetrics & Reproductive Medicine
  • Massachusetts
  • Mass Screening
  • Insurance Claim Review
  • Humans
  • Health Services Misuse