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Am J Perinatol 2019; 36(02): 212-218
DOI: 10.1055/s-0038-1667290
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Barriers to Postpartum Glucose Testing in Women with Gestational Diabetes Mellitus

Erika F. Werner
1   Alpert Medical School of Brown University, Providence, Rhode Island
,
Phinnara Has
2   Women & Infants Hospital, Providence, Rhode Island
,
Lindsey Kanno
2   Women & Infants Hospital, Providence, Rhode Island
,
Adam Sullivan
3   School of Public Health, Brown University, Providence, Rhode Island
,
Melissa A. Clark
4   University of Massachusetts Medical School, Worcester, Massachusetts
› Author Affiliations Funding This work was supported by the American Diabetes Association (grant 1–16-ICTS-118).
Further Information

Publication History

07 February 2018

15 June 2018

Publication Date:
30 July 2018 (online)

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Abstract

Objective To identify barriers to postpartum glucose testing in women with a history of gestational diabetes mellitus (GDM).

Materials and Methods This is a prospective cohort study of 300 women with GDM who completed questionnaires on socioeconomic barriers and validated instruments to measure trust in their clinician and health agency. At 12 weeks' postpartum, women were recontacted and postpartum records were collected. Women who completed glucose testing between 4 and 12 weeks' postpartum were compared with women who did not with regard to modifiable and nonmodifiable barriers to care.

Results Of the 373 women approached, 300 (80%) consented to participate, completed surveys on postpartum day 2, and had records retrieved at 12 weeks' postpartum. Validated instruments used showed internal consistency (Cronbach's α > 0.6). Only 126 (42%) of the participants completed postpartum glucose testing, and these women were more likely to have reliable transportation, private insurance, college degrees, and higher annual household incomes (p < 0.05). Postpartum glucose testing was also associated with trust in clinicians (p = 0.01) but not health agency (p = 0.66). The association between trust and postpartum glucose testing persisted after adjusting for nonmodifiable barriers.

Conclusion Maximizing trust in clinicians should be a focus of prenatal GDM care to maximize the likelihood of postpartum glucose testing.

Keywords

gestational diabetes - postpartum - glucose tolerance test - diabetes - prediabetes

Authors' Contributions

E. W. designed the project, wrote the manuscript, and oversaw data collection and analysis. P.H. assisted with designing the project and performed the analysis. L. K. was the primary data collector and assisted with writing the manuscript. A. S. provided statistical expertise and assisted with analysis plan and execution. M. C. designed the surveys, provided quality expertise, and assisted in writing the methods and discussion sections.


 

  • References

  • 1 Kim SY, Saraiva C, Curtis M, Wilson HG, Troyan J, Sharma AJ. Fraction of gestational diabetes mellitus attributable to overweight and obesity by race/ethnicity, California, 2007-2009. Am J Public Health 2013; 103 (10) e65-e72
    CrossrefPubMedSearch in Google Scholar
  • 2 Kim SY, Sharma AJ, Sappenfield W, Wilson HG, Salihu HM. Association of maternal body mass index, excessive weight gain, and gestational diabetes mellitus with large-for-gestational-age births. Obstet Gynecol 2014; 123 (04) 737-744
    CrossrefPubMedSearch in Google Scholar
  • 3 Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care 2008; 31 (05) 899-904
    CrossrefPubMedSearch in Google Scholar
  • 4 Ferrara A, Kahn HS, Quesenberry CP, Riley C, Hedderson MM. An increase in the incidence of gestational diabetes mellitus: Northern California, 1991-2000. Obstet Gynecol 2004; 103 (03) 526-533
    CrossrefPubMedSearch in Google Scholar
  • 5 Reinblatt SL, Morin L, Meltzer SJ. The importance of a postpartum 75 g oral glucose tolerance test in women with gestational diabetes. J Obstet Gynaecol Can 2006; 28 (08) 690-694
    CrossrefPubMedSearch in Google Scholar
  • 6 Kjos SL, Peters RK, Xiang A, Henry OA, Montoro M, Buchanan TA. Predicting future diabetes in Latino women with gestational diabetes. Utility of early postpartum glucose tolerance testing. Diabetes 1995; 44 (05) 586-591
    CrossrefPubMedSearch in Google Scholar
  • 7 Göbl CS, Bozkurt L, Prikoszovich T, Winzer C, Pacini G, Kautzky-Willer A. Early possible risk factors for overt diabetes after gestational diabetes mellitus. Obstet Gynecol 2011; 118 (01) 71-78
    CrossrefPubMedSearch in Google Scholar
  • 8 Tura A, Grassi A, Winhofer Y. , et al. Progression to type 2 diabetes in women with former gestational diabetes: time trajectories of metabolic parameters. PLoS One 2012; 7 (11) e50419
    CrossrefPubMedSearch in Google Scholar
  • 9 Werner EF, Has P, Tarabulsi G, Lee J, Satin A. Early post-partum diabetes screening for women with gestational diabetes mellitus. Am J Perinatol 2016; 33 (10) 966-971
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Ratner RE, Christophi CA, Metzger BE. , et al; Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 2008; 93 (12) 4774-4779
    CrossrefPubMedSearch in Google Scholar
  • 11 Aroda VR, Christophi CA, Edelstein SL. , et al; Diabetes Prevention Program Research Group. The effect of lifestyle intervention and metformin on preventing or delaying diabetes among women with and without gestational diabetes: the Diabetes Prevention Program outcomes study 10-year follow-up. J Clin Endocrinol Metab 2015; 100 (04) 1646-1653
    CrossrefPubMedSearch in Google Scholar
  • 12 Committee on Obstetric Practice. ACOG Committee Opinion No. 435: postpartum screening for abnormal glucose tolerance in women who had gestational diabetes mellitus. Obstet Gynecol 2009; 113 (06) 1419-1421
    CrossrefPubMedSearch in Google Scholar
  • 13 Bennett WL, Chang HY, Levine DM. , et al. Utilization of primary and obstetric care after medically complicated pregnancies: an analysis of medical claims data. J Gen Intern Med 2014; 29 (04) 636-645
    CrossrefPubMedSearch in Google Scholar
  • 14 Blatt AJ, Nakamoto JM, Kaufman HW. Gaps in diabetes screening during pregnancy and postpartum. Obstet Gynecol 2011; 117 (01) 61-68
    CrossrefPubMedSearch in Google Scholar
  • 15 Hale NL, Probst JC, Liu J, Martin AB, Bennett KJ, Glover S. Postpartum screening for diabetes among Medicaid-eligible South Carolina women with gestational diabetes. Womens Health Issues 2012; 22 (02) e163-e169
    CrossrefPubMedSearch in Google Scholar
  • 16 Smirnakis KV, Chasan-Taber L, Wolf M, Markenson G, Ecker JL, Thadhani R. Postpartum diabetes screening in women with a history of gestational diabetes. Obstet Gynecol 2005; 106 (06) 1297-1303
    CrossrefPubMedSearch in Google Scholar
  • 17 Bennett WL, Ennen CS, Carrese JA. , et al. Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: a qualitative study. J Womens Health (Larchmt) 2011; 20 (02) 239-245
    CrossrefPubMedSearch in Google Scholar
  • 18 Paez K, Roper RA, Andrews RM. Health information technology and hospital patient safety: a conceptual model to guide research. Jt Comm J Qual Patient Saf 2013; 39 (09) 415-425
    PubMedSearch in Google Scholar
  • 19 Van Ryswyk E, Middleton P, Hague W, Crowther C. Clinician views and knowledge regarding healthcare provision in the postpartum period for women with recent gestational diabetes: a systematic review of qualitative/survey studies. Diabetes Res Clin Pract 2014; 106 (03) 401-411
    CrossrefPubMedSearch in Google Scholar
  • 20 Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep 1990; 67 (3 Pt 2): 1091-1100
    PubMedSearch in Google Scholar
  • 21 Thom DH, Ribisl KM, Stewart AL, Luke DA. ; The Stanford Trust Study Physicians. Further validation and reliability testing of the Trust in Physician Scale. Med Care 1999; 37 (05) 510-517
    CrossrefPubMedSearch in Google Scholar
  • 22 Walker EA, Caban A, Schechter CB. , et al. Measuring comparative risk perceptions in an urban minority population: the risk perception survey for diabetes. Diabetes Educ 2007; 33 (01) 103-110
    CrossrefPubMedSearch in Google Scholar
  • 23 Graham JL, Shahani L, Grimes RM, Hartman C, Giordano TP. The influence of trust in physicians and trust in the healthcare lystem on Linkage, retention, and cdherence to HIV Care. AIDS Patient Care STDS 2015; 29 (12) 661-667
    CrossrefPubMedSearch in Google Scholar
  • 24 Bauer AM, Parker MM, Schillinger D. , et al. Associations between antidepressant adherence and shared decision-making, patient-provider trust, and communication among adults with diabetes: diabetes study of Northern California (DISTANCE). J Gen Intern Med 2014; 29 (08) 1139-1147
    CrossrefPubMedSearch in Google Scholar
  • 25 Bell RA, Arcury TA, Ip E. , et al. Correlates of physician trust among rural older adults with diabetes. Am J Health Behav 2013; 37 (05) 660-666
    CrossrefPubMedSearch in Google Scholar
  • 26 Kao AC, Green DC, Zaslavsky AM, Koplan JP, Cleary PD. The relationship between method of physician payment and patient trust. JAMA 1998; 280 (19) 1708-1714
    CrossrefPubMedSearch in Google Scholar
  • 27 McCloskey L, Bernstein J, Winter M, Iverson R, Lee-Parritz A. Follow-up of gestational diabetes mellitus in an urban safety net hospital: missed opportunities to launch preventive care for women. J Womens Health (Larchmt) 2014; 23 (04) 327-334
    CrossrefPubMedSearch in Google Scholar
  • 28 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; 128 (01) 159-167
    CrossrefPubMedSearch in Google Scholar
  • 29 Mendez-Figueroa H, Daley J, Breault P. , et al. Impact of an intensive follow-up program on the postpartum glucose tolerance testing rate. Arch Gynecol Obstet 2014; 289 (06) 1177-1183
    CrossrefPubMedSearch in Google Scholar
  • 30 Bryant AS, Haas JS, McElrath TF, McCormick MC. Predictors of compliance with the postpartum visit among women living in healthy start project areas. Matern Child Health J 2006; 10 (06) 511-516
    CrossrefPubMedSearch in Google Scholar