Within the context of Gestational Diabetes\' Effects on Moms (GEM), a pragmatic cluster randomized trial (2011-2012), we examined survey and electronic health record data to assess clinical and sociodemographic factors associated with uptake of ADA-recommended postpartum screening. Participants included 1642 women (76% racial/ethnic minorities) identified with GDM according to the Carpenter and Coustan criteria in a health system that deploys population-level strategies to promote screening. To contextualize these analyses, screening rates derived from the GEM trial were compared with those in the health system overall using registry data from a concurrent 10-year period (2007-2016, n=21 974).
Overall 52% (n=857) completed recommended postpartum screening in the analytic sample, comparable to 45.7% (n=10 040) in the registry. Screening in the analytic sample was less likely among women at elevated risk for type 2 diabetes, assessed using items from an ADA risk test (vs non-elevated; adjusted rate ratio (aRR)=0.86 (95% CI 0.75 to 0.98)); perinatal depression (0.88 (0.79 to 0.98)); preterm delivery (0.84 (0.72 to 0.98)); parity ≥2 children (vs 0; 0.80 (0.69 to 0.93)); or less than college education (0.79 (0.72 to 0.86)). Screening was more likely among Chinese Americans (vs White; 1.31 (1.15 to 1.49)); women who attended a routine postpartum visit (5.28 (2.99 to 9.32)); or women who recalled receiving healthcare provider advice about screening (1.31 (1.03 to 1.67)).
Guideline-recommended postpartum diabetes screening varied by patient clinical and sociodemographic factors. Findings have implications for developing future strategies to improve postpartum care.
在妊娠糖尿病对妈妈(GEM)的影响的背景下,一项实用的整群随机试验(2011-2012),我们检查了调查和电子健康记录数据,以评估与接受ADA推荐的产后筛查相关的临床和社会人口统计学因素.参与者包括根据卫生系统中的Carpenter和Coustan标准确定患有GDM的1642名妇女(76%的种族/族裔少数群体),该卫生系统部署了人口级战略以促进筛查。为了将这些分析背景化,使用同期10年的登记数据(2007-2016年,n=21974),将GEM试验的筛查率与整个卫生系统的筛查率进行了比较.
总体上52%(n=857)在分析样本中完成了推荐的产后筛查,与登记册中的45.7%(n=10040)相当。分析样本中的筛查在2型糖尿病风险升高的女性中不太可能,使用来自ADA风险测试的项目进行评估(vs非升高;调整后的比率(aRR)=0.86(95%CI0.75~0.98));围产期抑郁(0.88(0.79~0.98));早产(0.84(0.72~0.98));平价≥2名儿童(vs0;0.80(0.69~0.93));或低于大学学历(0.79(0.72~0.86)。在华裔美国人中,筛查的可能性更大(与白人相比;1.31(1.15至1.49));参加常规产后访视的妇女(5.28(2.99至9.32));或回忆接受过医疗保健提供者有关筛查建议的妇女(1.31(1.03至1.67))。
指南推荐的产后糖尿病筛查因患者临床和社会人口统计学因素而异。研究结果对制定改善产后护理的未来策略具有重要意义。