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

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.