Missed opportunities for appropriate postpartum care in women with pregestational diabetes. (2nd June 2016)

• Record Type: Journal Article
• Authors: Riskin-Mashiah, Shlomit; Almog, Ronit
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 29:Number 11(2016)
• Page Start: 1715
• Page End: 1719
• Publication Date: 2016-06-02
• Subjects: Glycemic control -- postpartum HbA1C -- quality of care -- type 1 or 2 diabetes; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.3109/14767058.2015.1062871
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Objective : Our aim was to evaluate postpartum glycemic control in women with pregestational diabetes and to assess contributing factors. Methods : Retrospective data collection from an electronic database on a cohort of Israeli women at Clalit Healthcare Services with pregestational diabetes who gave birth in 2008–2011, including data on HbA1C, prescription fillings, and socio-demographics. HbA1C level was assessed during a 2 year time-period, from periconception until one-year postpartum. Results : There were 180 deliveries to 166 women. Compared with the periconception period, the HbA1C level improved significantly during the last 6 months of pregnancy (6.7% versus 6.0%, p < 0.05). However, there was rapid continuous deterioration in glycemic control in the postpartum period with median HbA1C = 6.9% in the first 6 months postpartum and 7.2% in the late postpartum period ( p < 0.05). One-year postpartum 107 women (59.4%) had suboptimal care (defined as HbA1C > 7.0% or no test). In the multiple logistic regression analysis, the only significant predictor of 1-year postpartum suboptimal care was suboptimal periconception care, OR = 6.1 (95% CI 3.15–11.84, p = 0.001). Conclusions : Postpartum glycemic control deteriorated rapidly despite excellent control in most women in the last 6 month of pregnancy. More intensive and targeted intervention is needed in order to optimize postpartum care of diabetic patients.