Online Program

Health care of women before, during, and after a pregnancy complicated by gestational diabetes or hypertension

Monday, November 4, 2013

Kristin Maiden, PhD, Department of Obstetrics and Gynecology, Christiana Care Health System, Newark, DE
Stephanie Rogers, MSN, RN, Obstetrics and Gynecology, Christiana Care Health System, Newark, DE
Victoria Kopec, College of Arts and Sciences, University of Delaware, Newark, DE
Deborah Ehrenthal, MD, MPH, Obstetrics and Gynecology and Internal Medicine, Christiana Care Health System, Newark, DE
Background: Gestational diabetes and hypertension identify women at high risk for future cardiovascular disease.

Methods: We conducted a prospective cohort study of 199 women whose pregnancy was complicated by gestational diabetes (GDM) or pregnancy associated hypertension (HTN) at a large obstetrical hospital. Baseline data obtained at hospital discharge and for 145 (73%) 3 months later included measures of stress, depression, health literacy, and social support using validated scales and self-reported receipt of health care. The predictors of preventive health care were tested using chi-square, t-test, and Mann-Whitney U test.

Results: 48.2% had GDM, 55.8% HTN, and 4% both. 85.9% of women had a primary care provider (PCP) and 37.7% saw their PCP during their pregnancy. Among women with GDM: 57% reported follow-up testing for diabetes. Women who were unmarried (p=<0.001) Medicaid-insured (p<0.001), no college education (p=0.02), or low health literacy (p=.03) were less likely to receive follow-up testing for diabetes. Among women with HTN: 51% recalled ever completing a lipid panel. Women <30 years (p<0.01) had Medicaid (p<0.05), or had no college education (p<0.001) were less likely to have had their cholesterol measured. Stress, depression, social support and health literacy were not significantly related.

Conclusions: Women with medically complicated pregnancies were well-connected to health care before, during and after pregnancy. Low completed education, marital status, and not having private insurance were each significantly related to not completing follow-up care. These findings suggest a stronger system of care is needed and provides a strategy to address health disparities.

Learning Areas:

Administer health education strategies, interventions and programs
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs

Learning Objectives:
Discuss gaps in health care for women after a pregnancy complication

Keyword(s): Prevention, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As Director of Health Services Research for Women and Children at a large hospital system I have experience in both qualitative and quantitative research methods. I have been a principal investigator or co-investigator for multiple contracts and grants focusing on the health and health care of women during their reproductive years. I have published results of my research in peer-reviewed journals with a focus on women’s and children’s health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.