Half of patients with gestational diabetes follow up with primary care after giving birth

About 50% of patients with gestational diabetes followed up with primary care in the first year postpartum, despite guidelines recommending universal follow up to improve health outcomes, according to results published in JAMA Network Open.

Rachel D’Amico, MD, a primary care physician at The Ohio State University Wexner Medical Center, and colleagues wrote that little is known about how often people with gestational diabetes (GD) access primary care and screening for type 2 diabetes, despite the fact that GD affects nearly one in 10 pregnancies and causes a 10-fold increased lifetime risk for type 2 diabetes.

D’Amico and colleagues conducted a cohort study using a private insurance claims database to evaluate comparisons in follow-up care between people with GD, type 2 diabetes or no diabetes diagnosis. They included 280,131 participants aged 15 to 52 years — 18,432 with GD and 12,242 with preexisting type 2 diabetes. All participants gave birth between 2015 and 2018 and were continuously enrolled from 180 days before delivery to 1 year after the delivery date.

D’Amico and colleagues found that 50.9% (95% CI, 49.9-52) of people with GD followed up with primary care compared with 67.2% (95% CI, 66.2-68.2) of individuals with preexisting type 2 diabetes.

Of those with GD who were connected with primary care, just 36% (95% CI, 34.4-37.6) received blood glucose testing 3 months postpartum, as is recommended by the American Diabetes Association, according to the researchers.

“Early follow-up of GD may help to prevent or detect type 2 diabetes earlier, allow opportunities for promotion of improving cardiovascular health, and prevent the significant morbidity related to uncontrolled diabetes,” the researchers wrote. “As GD prevalence increases, it is critical we determine how to increase follow-up rates.”

Additionally, 36.2% (95% CI, 35.1-37.4) of participants with GD and 56.9% (95% CI, 55.7-58) of those with preexisting diabetes received diabetes-related care.

D’Amico and colleagues concluded that, compared with people who had preexisting type 2 diabetes, those with GD had lower rates of primary care and diabetes-related care.

“This cohort study demonstrated concerningly low rates of postpartum engagement in what is, to our knowledge, the largest study of primary care follow-up in GD to date,” they wrote. “A paradigm shift in how we view GD, not as an acute issue that resolves with birth but as a chronic disease process and independent cardiovascular risk factor, is necessary to ensure appropriate care of patients with GD.”

These results, they wrote, demonstrate the need to develop a multidisciplinary approach for postpartum follow-up and illustrate the missed opportunities for early diabetes intervention.

“Further research is needed to characterize which patients are at the highest risk for not receiving appropriate postpartum follow-up, as well as identifying barriers to post-GD primary care transitions, to further target interventions,” the researchers wrote.