Abstract：
BACKGROUND: Gestational diabetes mellitus (GDM), a common complication of pregnancy, is associated with a 10-fold increased risk of type 2 diabetes mellitus (T2DM) compared to the general population. Evidence-based guidelines recommend that patients with GDM receive postpartum care for T2DM risk reduction including an oral glucose tolerance test (OGTT) 4-12 weeks after delivery, yet half of patients with GDM did not return for their postpartum visits by 12 weeks postpartum. Additionally, only 10% utilize primary care within 12 months of delivery and one-third of GDM patients receive timely postpartum OGTT.
OBJECTIVE: To determine if the Mother-Infant Dyad postpartum primary care program provides a framework to link well-child visits with postpartum primary care visits to increase postpartum clinical interactions promoting longitudinal care, such as postpartum visit attendance and T2DM screening.
METHODS: All patients with a diagnosis of GDM that received care at a postpartum mother-infant dyad program at a Midwestern academic medical center internal medicine and pediatrics primary care clinic were enrolled. Clinic level data was obtained by baseline and 6-month post-enrollment surveys and chart review. A comparison population was identified from Medicaid claims data using propensity score matching to enable a comparison of program participants\' outcomes to a population comprised of similar individuals diagnosed with GDM that received care at sites not participating in the Dyad program. Our primary outcome was completion of T2DM screening in the 4-12 week postpartum period. The secondary outcomes were postpartum visit attendance with a prenatal provider, and prediabetes diagnoses.
RESULTS: A total of 75 mother-infant dyads were seen by the clinic. Of the enrolled women, 43% were Non-Hispanic White and 30% were Non-Hispanic Black; mean age was 30.75 years. The matched comparison group (n = 62) had a mean age of 30.75 years, were 43% Non-Hispanic White and 30% Non-Hispanic Black. Women who participated in the program were more likely to receive T2DM screenings than women who did not participate (87 vs. 79%, p<.001) and complete postpartum visits (95 vs. 58%, respectively; p<.001). Additionally, a higher rate of new prediabetes diagnoses was observed (12 vs. 6%, p < .001).
CONCLUSIONS: The Mother-Infant Dyad postpartum primary care program improved T2DM screenings and postpartum visit attendance. In addition, a greater proportion of Dyad program participants experienced new prediabetes diagnoses that those in the comparison group. Our findings suggest that the dyad care model, in which women with GDM engage in postpartum primary care concurrent with well-child visits, can improve longitudinal postpartum care after a GDM diagnosis.
OBJECTIVE: To determine if the Mother-Infant Dyad postpartum primary care program provides a framework to link well-child visits with postpartum primary care visits to increase postpartum clinical interactions promoting longitudinal care, such as postpartum visit attendance and T2DM screening.
METHODS: All patients with a diagnosis of GDM that received care at a postpartum mother-infant dyad program at a Midwestern academic medical center internal medicine and pediatrics primary care clinic were enrolled. Clinic level data was obtained by baseline and 6-month post-enrollment surveys and chart review. A comparison population was identified from Medicaid claims data using propensity score matching to enable a comparison of program participants\' outcomes to a population comprised of similar individuals diagnosed with GDM that received care at sites not participating in the Dyad program. Our primary outcome was completion of T2DM screening in the 4-12 week postpartum period. The secondary outcomes were postpartum visit attendance with a prenatal provider, and prediabetes diagnoses.
RESULTS: A total of 75 mother-infant dyads were seen by the clinic. Of the enrolled women, 43% were Non-Hispanic White and 30% were Non-Hispanic Black; mean age was 30.75 years. The matched comparison group (n = 62) had a mean age of 30.75 years, were 43% Non-Hispanic White and 30% Non-Hispanic Black. Women who participated in the program were more likely to receive T2DM screenings than women who did not participate (87 vs. 79%, p<.001) and complete postpartum visits (95 vs. 58%, respectively; p<.001). Additionally, a higher rate of new prediabetes diagnoses was observed (12 vs. 6%, p < .001).
CONCLUSIONS: The Mother-Infant Dyad postpartum primary care program improved T2DM screenings and postpartum visit attendance. In addition, a greater proportion of Dyad program participants experienced new prediabetes diagnoses that those in the comparison group. Our findings suggest that the dyad care model, in which women with GDM engage in postpartum primary care concurrent with well-child visits, can improve longitudinal postpartum care after a GDM diagnosis.
摘要：
背景：妊娠期糖尿病（GDM），怀孕的常见并发症，与普通人群相比，2型糖尿病（T2DM）的风险增加了10倍。循证指南建议GDM患者在分娩后4-12周接受产后护理以降低T2DM风险，包括口服葡萄糖耐量试验（OGTT）。然而,一半的GDM患者在产后12周时仍未复诊.此外,只有10%的GDM患者在分娩后12个月内使用初级保健,1/3的GDM患者及时接受产后OGTT.
目的：确定母婴Dyad产后初级保健计划是否提供了一个框架，将良好的孩子访视与产后初级保健访视联系起来，以增加产后临床互动，促进纵向护理，如产后就诊和T2DM筛查。
方法：所有诊断为GDM的患者均在中西部学术医学中心内科和儿科初级保健诊所的产后母婴二联计划中接受护理。临床水平的数据是通过基线和6个月后的调查和图表审查获得的。使用倾向得分匹配从医疗补助索赔数据中确定比较人群，以使计划参与者的结果与在未参与Dyad计划的地点接受护理的被诊断为GDM的相似个体组成的人群进行比较。我们的主要结果是在产后4-12周完成T2DM筛查。次要结果是产前提供者的产后就诊，和糖尿病前期诊断。
结果：诊所共发现75个母婴二联。在登记的妇女中，43％为非西班牙裔白人，30％为非西班牙裔黑人；平均年龄为30.75岁。匹配的对照组（n=62）的平均年龄为30.75岁，有43%的非西班牙裔白人和30%的非西班牙裔黑人。参加该计划的女性比没有参加的女性更有可能接受T2DM筛查（87vs.79%,p<.001）和完整的产后访视（95vs.58%,分别；p<.001）。此外,观察到新的糖尿病前期诊断率较高(12vs.6%,p<.001)。
结论：母婴Dyad产后初级保健计划改善了T2DM筛查和产后就诊率。此外,Dyad计划参与者经历新的糖尿病前期诊断的比例高于对照组.我们的研究结果表明，二元护理模式，其中GDM妇女在产后初级保健的同时进行良好的孩子访问，可以改善GDM诊断后的纵向产后护理。
目的：确定母婴Dyad产后初级保健计划是否提供了一个框架，将良好的孩子访视与产后初级保健访视联系起来，以增加产后临床互动，促进纵向护理，如产后就诊和T2DM筛查。
方法：所有诊断为GDM的患者均在中西部学术医学中心内科和儿科初级保健诊所的产后母婴二联计划中接受护理。临床水平的数据是通过基线和6个月后的调查和图表审查获得的。使用倾向得分匹配从医疗补助索赔数据中确定比较人群，以使计划参与者的结果与在未参与Dyad计划的地点接受护理的被诊断为GDM的相似个体组成的人群进行比较。我们的主要结果是在产后4-12周完成T2DM筛查。次要结果是产前提供者的产后就诊，和糖尿病前期诊断。
结果：诊所共发现75个母婴二联。在登记的妇女中，43％为非西班牙裔白人，30％为非西班牙裔黑人；平均年龄为30.75岁。匹配的对照组（n=62）的平均年龄为30.75岁，有43%的非西班牙裔白人和30%的非西班牙裔黑人。参加该计划的女性比没有参加的女性更有可能接受T2DM筛查（87vs.79%,p<.001）和完整的产后访视（95vs.58%,分别；p<.001）。此外,观察到新的糖尿病前期诊断率较高(12vs.6%,p<.001)。
结论：母婴Dyad产后初级保健计划改善了T2DM筛查和产后就诊率。此外,Dyad计划参与者经历新的糖尿病前期诊断的比例高于对照组.我们的研究结果表明，二元护理模式，其中GDM妇女在产后初级保健的同时进行良好的孩子访问，可以改善GDM诊断后的纵向产后护理。
