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Am J Perinatol 2019; 36(02): 212-218
DOI: 10.1055/s-0038-1667290
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Barriers to Postpartum Glucose Testing in Women with Gestational Diabetes Mellitus

Erika F. Werner
1   Alpert Medical School of Brown University, Providence, Rhode Island
,
Phinnara Has
2   Women & Infants Hospital, Providence, Rhode Island
,
Lindsey Kanno
2   Women & Infants Hospital, Providence, Rhode Island
,
Adam Sullivan
3   School of Public Health, Brown University, Providence, Rhode Island
,
Melissa A. Clark
4   University of Massachusetts Medical School, Worcester, Massachusetts
› Author Affiliations Funding This work was supported by the American Diabetes Association (grant 1–16-ICTS-118).
Further Information

Publication History

07 February 2018

15 June 2018

Publication Date:
30 July 2018 (online)

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Abstract

Objective To identify barriers to postpartum glucose testing in women with a history of gestational diabetes mellitus (GDM).

Materials and Methods This is a prospective cohort study of 300 women with GDM who completed questionnaires on socioeconomic barriers and validated instruments to measure trust in their clinician and health agency. At 12 weeks' postpartum, women were recontacted and postpartum records were collected. Women who completed glucose testing between 4 and 12 weeks' postpartum were compared with women who did not with regard to modifiable and nonmodifiable barriers to care.

Results Of the 373 women approached, 300 (80%) consented to participate, completed surveys on postpartum day 2, and had records retrieved at 12 weeks' postpartum. Validated instruments used showed internal consistency (Cronbach's α > 0.6). Only 126 (42%) of the participants completed postpartum glucose testing, and these women were more likely to have reliable transportation, private insurance, college degrees, and higher annual household incomes (p < 0.05). Postpartum glucose testing was also associated with trust in clinicians (p = 0.01) but not health agency (p = 0.66). The association between trust and postpartum glucose testing persisted after adjusting for nonmodifiable barriers.

Conclusion Maximizing trust in clinicians should be a focus of prenatal GDM care to maximize the likelihood of postpartum glucose testing.

Keywords

gestational diabetes - postpartum - glucose tolerance test - diabetes - prediabetes

Authors' Contributions

E. W. designed the project, wrote the manuscript, and oversaw data collection and analysis. P.H. assisted with designing the project and performed the analysis. L. K. was the primary data collector and assisted with writing the manuscript. A. S. provided statistical expertise and assisted with analysis plan and execution. M. C. designed the surveys, provided quality expertise, and assisted in writing the methods and discussion sections.


 

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