Mother-Infant Dyad program in primary care: evidence-based postpartum care following gestational diabetes

Abstract

Background

Gestational diabetes mellitus (GDM), a common complication of pregnancy, is associated with a 10-fold increased risk of type 2 diabetes mellitus (T2DM) compared to the general population. Evidence-based guidelines recommend that patients with GDM receive postpartum care for T2DM risk reduction including an oral glucose tolerance test (OGTT) 4-12 weeks after delivery, yet half of patients with GDM did not return for their postpartum visits by 12 weeks postpartum. Additionally, only 10% utilize primary care within 12 months of delivery and one-third of GDM patients receive timely postpartum OGTT.

Objective

To determine if the Mother-Infant Dyad postpartum primary care program provides a framework to link well-child visits with postpartum primary care visits to increase postpartum clinical interactions promoting longitudinal care, such as postpartum visit attendance and T2DM screening.

Study design

All patients with a diagnosis of GDM that received care at a postpartum mother-infant dyad program at a Midwestern academic medical center internal medicine and pediatrics primary care clinic were enrolled. Clinic level data was obtained by baseline and 6-month post-enrollment surveys and chart review. A comparison population was identified from Medicaid claims data using propensity score matching to enable a comparison of program participants’ outcomes to a population comprised of similar individuals diagnosed with GDM that received care at sites not participating in the Dyad program. Our primary outcome was completion of T2DM screening in the 4–12 week postpartum period. The secondary outcomes were postpartum visit attendance with a prenatal provider, and prediabetes diagnoses.

Results

A total of 75 mother-infant dyads were seen by the clinic. Of the enrolled women, 43% were Non-Hispanic White and 30% were Non-Hispanic Black; mean age was 30.75 years. The matched comparison group (n = 62) had a mean age of 30.75 years, were 43% Non-Hispanic White and 30% Non-Hispanic Black. Women who participated in the program were more likely to receive T2DM screenings than women who did not participate (87 vs. 79%, p<.001) and complete postpartum visits (95 vs. 58%, respectively; p<.001). Additionally, a higher rate of new prediabetes diagnoses was observed (12 vs. 6%, p < .001).

Conclusion

The Mother-Infant Dyad postpartum primary care program improved T2DM screenings and postpartum visit attendance. In addition, a greater proportion of Dyad program participants experienced new prediabetes diagnoses that those in the comparison group. Our findings suggest that the dyad care model, in which women with GDM engage in postpartum primary care concurrent with well-child visits, can improve longitudinal postpartum care after a GDM diagnosis.

Keywords:

• Dyad
• gestational diabetes mellitus
• joint care
• postpartum
• primary care
• type 2 diabetes mellitus

Acknowledgments

The authors would like to acknowledge Elizabeth Conrey, PhD, RD, for her insightful comments on this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s). The views expressed in this publication are solely those of the authors and do not represent the views of the state of Ohio or federal Medicaid programs. Sponsors were not involved in the collection, analysis or interpretation of the data, but did contribute to writing and reviewing this manuscript.

Notes

1 Diagnoses were identified using the International Classification of Diseases (ICD) 10 codes recommended by the Healthcare Effectiveness Data and Information Set (HEDIS) for creating measures of T2DM.

2 Prior to analysis, REDCap data were joined with data from ODM claims, and Vital Statistics birth records using Link Plus, a probabilistic record linkage program. An algorithm was employed to identify records for women who were the most likely matches with program participants based on first and last names, dates of birth and zip codes. All candidate matches were manually reviewed to confirm accuracy.

Additional information

Funding

This work was sponsored by the Ohio Department of Health and the Ohio Department of Medicaid, and administered by the Ohio Colleges of Medicine Government Resource Center.