Introduction
Women with gestational diabetes are 7 times more likely to develop type 2 diabetes
and require lifelong diabetes screening. Loss of health coverage after pregnancy,
as occurs in states that did not expand Medicaid, limits access to guideline-driven
follow-up care and fosters health inequity. This study aims to understand the factors
associated with the receipt of postpartum diabetes screening for women with gestational
diabetes in a state without Medicaid expansion.
Methods
Electronic health record and Medicaid claims data were linked to generate a retrospective
cohort of 1,078 women with gestational diabetes receiving care in Federally Qualified
Health Centers in Missouri from 2010 to 2015. In 2019–2020, data were analyzed to
determine the factors associated with the receipt of recommended postpartum diabetes
screening (fasting plasma glucose, 2-hour oral glucose tolerance test, or HbA1c in
specified timeframes) using a Cox proportional hazards model through 18 months of
follow-up.
Results
Median age in this predominantly urban population was 28 (IQR=24−33) years. Self-reported
racial or ethnic minorities comprised more than half of the population. Only 9.7%
of women were screened at 12 weeks, and 20.8% were screened at 18 months. Prenatal
certified diabetes education (adjusted hazard ratio=1.74, 95% CI=1.22, 2.49) and access
to public transportation (adjusted hazard ratio=1.70, 95% CI=1.13, 2.54) were associated
with increased screening in a model adjusted for race/ethnicity, the total number
of prenatal visits, the use of diabetes medication during pregnancy, and a pregnancy-specific
comorbidity index that incorporated age.
Conclusions
This study underscores the importance of access to public transportation, prenatal
diabetes education, and continued healthcare coverage for women on Medicaid to support
the receipt of guideline-recommended follow-up care and improve health equity.
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Article Info
Publication History
Published online: December 11, 2020
Identification
Copyright
© 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
