Abstract：
Clinical guidelines urge timely postpartum screening for diabetes among women with gestational diabetes mellitus (GDM), yet patient factors associated with screening uptake remain unclear. We aimed to identify patient factors associated with completed postpartum diabetes screening (2-hour oral glucose tolerance test within 4-12 weeks postpartum), as recommended by the American Diabetes Association (ADA).
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.
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.
摘要：
临床指南敦促妊娠期糖尿病（GDM）妇女及时进行产后糖尿病筛查，然而,与筛查摄取相关的患者因素仍不清楚.我们旨在确定与完成产后糖尿病筛查（产后4-12周内2小时口服葡萄糖耐量试验）相关的患者因素，根据美国糖尿病协会（ADA）的建议。
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。
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。
