Gaps in postpartum counseling for women with diabetes, hypertension, and smoking before and during pregnancy: Findings from the 2007 Los Angeles Mommy and Baby (LAMB) Survey

Objective: To identify the content of health care provider counseling at the postpartum visit for a population-based sample of women from Los Angeles County with diabetes, hypertension, or smoking before and during pregnancy. Methods: We used data from the 2007 LAMB survey, a population-based, mail sample survey with telephone follow-up for non-respondents based on multistage clustered design. Analyses were based on unweighted responses of 3658 women with live births. Diabetes, hypertension, and smoking were assessed for periods six months prior to respondents finding out they were pregnant (pre-pregnancy) and during pregnancy. Postpartum content was assessed by asking respondents if "during their postpartum checkup," their doctor or nurse talked about "taking care of blood sugar," "taking care of blood pressure," and "stopping smoking." Results: Twenty-eight percent of women with pre-gestational diabetes and 34% of women with gestational diabetes reported receiving no counseling regarding blood sugar management at the postpartum visit. Similarly, 35% of women with hypertension pre-pregnancy and 44% of women with hypertension during pregnancy reported receiving no counseling about blood pressure control. Seventy-nine percent of women who smoked pre-pregnancy and 66% who smoked during pregnancy reported no counseling about smoking cessation. There were significant racial-ethnic disparities in receipt of counseling about diabetes, hypertension, and smoking (p<0.01). Discussion: Pregnancy may reveal a woman's long-term health risks. For women reporting diabetes, hypertension, or smoking before and during pregnancy, many did not receive counseling regarding these health risks during their postpartum visit. These represent important missed opportunities for disease prevention and health promotion. 6-2010-->