Mother-Infant Dyad program in primary care: evidence-based postpartum care following gestational diabetes

Brill, Seuli; May, Sara M.; Lorenz, Allison; Spence, Douglas; Prater, Laura; Shellhaas, Cynthia; Otsubo, Masami; Mao, Shengyi; Flanigan, Matthew; Thung, Stephen; Leonard, Melissa; Jiang, Fei; Oza-Frank, Reena

doi:10.1080/14767058.2022.2032633

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…There are promising care models to help improve GD follow-up. Maternal-infant dyad clinics—with a joint encounter for parent and infant—have been shown to increase GD follow-up and appropriate screening . By taking advantage of other encounters in which parents interface with the health care system, like well child visits, clinicians may be able to connect postpartum patients with the medical care they need.…”

Section: Discussionmentioning

confidence: 99%

“…Maternal-infant dyad clinicswith a joint encounter for parent and infant-have been shown to increase GD follow-up and appropriate screening. 10 By taking advantage of other encounters in which parents interface with the health care system, like well child visits, clinicians may be able to connect postpartum patients with the medical care they need. Patient contact with a health educator, via phone or mail, has also been shown to increase follow-up blood glucose testing.…”

Section: Jama Network Open | Public Healthmentioning

confidence: 99%

“…9 Postpartum primary care linkage has been demonstrated to improve rates of timely type 2 diabetes screening, postpartum follow-up, and diagnoses of prediabetes. 10 However, only about half of all postpartum patients follow up with a primary care practitioner in the 12 months after delivery. National data on GD primary care follow-up are sparse and limited to those with continuous private insurance enrollment of over 4 years, 11 but show low rates of blood glucose follow-up.…”

Section: Introductionmentioning

confidence: 99%

“…Postpartum primary care serves as a critical component of longitudinal follow-up for conditions like GD, and is recommended by both the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine . Postpartum primary care linkage has been demonstrated to improve rates of timely type 2 diabetes screening, postpartum follow-up, and diagnoses of prediabetes . However, only about half of all postpartum patients follow up with a primary care practitioner in the 12 months after delivery.…”

Section: Introductionmentioning

confidence: 99%

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Patterns of Postpartum Primary Care Follow-up and Diabetes-Related Care After Diagnosis of Gestational Diabetes

et al. 2023

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ImportanceGestational diabetes (GD) affects up to 10% of pregnancies and increases lifetime risk of type 2 diabetes 10-fold; postpartum diabetes evaluation and primary care follow-up are critical in preventing and detecting type 2 diabetes. Despite clinical guidelines recommending universal follow-up, little remains known about how often individuals with GD access primary care and type 2 diabetes screening.ObjectiveTo describe patterns of primary care follow-up and diabetes-related care among individuals with and without GD in the first year post partum.Design, Setting, and ParticipantsThis cohort study used a private insurance claims database to compare follow-up in the first year post partum between individuals with GD, type 2 diabetes, and no diabetes diagnosis. Participants included postpartum individuals aged 15 to 51 years who delivered between 2015 and 2018 and had continuous enrollment from 180 days before to 366 days after the delivery date. Data were analyzed September through October 2021 and reanalyzed November 2022.Main Outcomes and MeasuresPrimary care follow-up visits and diabetes-related care (blood glucose testing and diabetes-associated visit diagnoses) were determined by evaluation and management, Current Procedural Terminology, and International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes, respectively.ResultsA total of 280 131 individuals were identified between 2015 and 2018 (mean age: 31 years; 95% CI, 27-34 years); 12 242 (4.4%) had preexisting type 2 diabetes and 18 432 (6.6%) had GD. A total of 50.9% (95% CI, 49.9%-52.0%) of individuals with GD had primary care follow-up, compared with 67.2% (95% CI, 66.2%-68.2%) of individuals with preexisting type 2 diabetes. A total of 36.2% (95% CI, 35.1%-37.4%) of individuals with GD had diabetes-related care compared with 56.9% (95% CI, 55.7%-58.0%) of individuals with preexisting diabetes. Only 36.0% (95% CI, 34.4%-37.6%) of individuals with GD connected with primary care received clinical guideline concordant care with blood glucose testing 12 weeks post partum.Conclusions and RelevanceIn this cohort study of postpartum individuals, individuals with GD had lower rates of primary care and diabetes-related care compared with those with preexisting type 2 diabetes, and only 36% of those with GD received guideline-recommended blood glucose testing in the first 12 weeks post partum. This illustrates a missed opportunity for early intervention in diabetes surveillance and prevention and demonstrates the need to develop a multidisciplinary approach for postpartum follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Public Healthmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Patterns of Postpartum Primary Care Follow-up and Diabetes-Related Care After Diagnosis of Gestational Diabetes

et al. 2023

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“…Emerging programs have also considered dyad approaches for families affected by opioid use or after gestational diabetes. 31 , 32 These programs emphasize some features in common with recommendations from our participants, including roles to support navigation and collocation of services. 31 , 32 One program was developed with reference to the chronic care model.…”

Section: Discussionmentioning

confidence: 99%

Integrating Care for Mother–Infant Dyads After Preterm Birth: A Qualitative Study of Clinician Perspectives on Feasibility

Gregory,

Cronholm,

Levine

et al. 2023

Women's Health Reports

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Objective: There are gaps in receipt of maternal preventive services in the interconception period. Yet mother–infant dyads have frequent health care visits. Health systems have opportunities to better capitalize on existing visits to address dyad needs, but this possibility has not been fully explored. Methods: In this qualitative study we conducted semistructured interviews with clinical team members involved with birthing parents or infants after preterm birth. We conducted snowball sampling from teams in pediatrics, obstetrics, and family medicine at two geographically adjacent health systems. Interviews explored perspectives on existing barriers and facilitators to integrating dyad care across adult and infant teams. Interviews were audio-recorded, professionally transcribed, and coded using an integrated approach. Results: We interviewed 24 physicians, nurses, midwives, and social workers (March–November 2021). Participants identified barriers to integrated care including infrequent communication between clinical teams, which was generalizable to care of the birthing parent or infant as individuals, and additional barriers related to privacy, credentialing, and visit design that were specific to dyad care. To improve integration of dyad care, clinicians proposed adapting a variety tools and procedures currently used in their practices, including electronic health record tools for communication, dedicated roles to support communication or navigation, centralized information on resources for dyad care, referral protocols, identifying dyads for proactive outreach, and opportunities for clinicians to connect face-to-face about shared patients or families. Conclusions: Clinicians believe existing health care structures and processes can be adapted to address current substantial barriers to integrated dyad care.

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Strategies to improve postpartum engagement in healthcare after high-risk conditions diagnosed in pregnancy: a narrative review

Whyler,

Krishnaswamy,

Price

et al. 2024

Arch Gynecol Obstet

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Transition from antepartum to postpartum care is important, but often fragmented, and attendance at postpartum visits can be poor. Access to care is especially important for individuals diagnosed antepartum with conditions associated with longer-term implications, including gestational diabetes (GDM) and hypertensive disorders in pregnancy (HDP). Strategies to link and strengthen this transition are essential to support people to attend recommended appointments and testing. This narrative review evaluates what is known about postpartum transition of care after higher-risk antepartum conditions, discusses barriers and facilitators to uptake of recommended testing, and outlines strategies trialled to increase both postpartum attendance and testing. Barriers to attendance frequently overlap with general barriers to accessing healthcare. Specific postpartum challenges include difficulties with transport, coordinating breastfeeding and childcare access. Systemic challenges include inadequate communication to women around implications of health conditions diagnosed in pregnancy, and the importance of postpartum follow up. Uptake of recommended testing after a diagnosis of GDM and HDP is variable but generally suboptimal. Strategies which demonstrate promise include the use of patient navigators, focused education and specialised clinics. Reminder systems have had variable impact. Telehealth and technology are under-utilised in this field but offer promising options particularly with the expansion of virtual healthcare into routine maternity care. Strategies to improve both attendance rates and uptake of testing must be designed to address disparities in healthcare access and tailored to the needs of the community. This review provides a starting point to develop such strategies from the community level to the population level.

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Mother-Infant Dyad program in primary care: evidence-based postpartum care following gestational diabetes

Cited by 8 publications

References 24 publications

Patterns of Postpartum Primary Care Follow-up and Diabetes-Related Care After Diagnosis of Gestational Diabetes

Patterns of Postpartum Primary Care Follow-up and Diabetes-Related Care After Diagnosis of Gestational Diabetes

Integrating Care for Mother–Infant Dyads After Preterm Birth: A Qualitative Study of Clinician Perspectives on Feasibility

Strategies to improve postpartum engagement in healthcare after high-risk conditions diagnosed in pregnancy: a narrative review

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