Continued Disparities in Postpartum Follow-Up and Screening Among Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy

Abstract

The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among United States (U.S.) women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to Black race and Hispanic ethnicity, low level of education, and co-existing morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist vs. primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear if follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population level data to inform equitable progress to meeting the evidence-informed guidelines.

Low-Carbohydrate Diets for Gestational Diabetes

“…More concerning is that prospective RCTs in which lifestyle changes, including nutrition, were initiated during early pregnancy and have been unsuccessful overall in preventing GDM in at-risk obese women [31,32]. Postpartum follow-up of these mothers tends to be poor [33]. It was recently identified in the HAPO cohort that 11 years after GDM, the higher incidence of childhood overweight/obesity, increased adiposity, and larger waist circumference was explained by pre-pregnancy BMI [34].…”

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“…In the United States, this gap is further exacerbated by racial and ethnic inequities in health care (Martin et al, 2018;McCloskey et al, 2019b). Black, Latina, and Native women are least likely to be tested and followed despite their disproportionate risk of type 2 diabetes (Jones, Hernandez, Edmonds, & Ferranti, 2019). These observations highlight the asymmetry between the significant attention to and investment in pregnant people aimed at healthy babies versus the under-investment in women's own health and well-being before, between, and beyond pregnancy.…”

It's Time to Eliminate Racism and Fragmentation in Women's Health Care

“…Up to 60% of women with gestational diabetes may go on to develop type 2 diabetes in the following decade, yet only 20%-55% receive the recommended follow-up testing and connection to primary care in the 1-3 years after pregnancy (Bernstein et al, 2017;Shah, Lipscombe, Feig, & Lowe, 2011;Stuart et al, 2018). Moreover, Black, Latina, and Native women are most likely to develop type 2 diabetes, yet least likely to receive follow-up care (Jones, Hernandez, Edmonds, & Ferranti, 2019;McCloskey, Bernstein, Winter, Iverson, & Lee-Parritz, 2014;McCloskety et al, 2019).…”