Diabetes in pregnancy: The other silent killer
objective: To describe systems-level barriers impeding healthy birth outcomes for women with diabetes in pregnancy.
methods: IHB-FIMR conducted maternal interviews and an in-depth analysis of medical records of women with diabetes who experienced a loss. IHB-FIMR convened a multidisciplinary team to review de-identified medical record data and interview transcripts to prioritize key indicators for systems change.
results: Four systems-level focus areas emerged: (1) pre and interconception care opportunities are scarce and underutilized (planned pregnancies-17%, unmanaged diabetes at time of conception-84.6%, previous early loss-48%); (2) postpartum visits are missed opportunities for diabetes follow-up (attended postpartum appointment-67%, received follow-up services-21.2%); (3) vital records data is missing or inaccurate, compromising future research; (4) maternal non-compliance is complicated by lack of insurance, housing instability, transportation issues, maternal mental health, inadequate social support, and communication barriers.
conclusion: Addressing systems-level barriers to diabetes management represents a distinct and actionable area to improve services and focus public health policy efforts aimed at reducing disparities in birth outcomes.
Learning Areas:Advocacy for health and health education
Assessment of individual and community needs for health education
Chronic disease management and prevention
Diversity and culture
Public health or related public policy
Describe 4 systems-level focus areas for local maternal and child health service improvement and policy development. Explain the IHB-FIMR holistic program methodology. Discuss action-oriented strategies to improve pregnancy outcomes for underserved women and ethnic minorities with diabetes before, during, and after pregnancy.
Keyword(s): Birth Outcomes, Diabetes
Qualified on the content I am responsible for because: I have been the co-investigator on the majority of the IHB-FIMR maternal diabetes cases analyzed and presented here. I have worked with women diagnosed with diabetes before, during and after pregnancy in a clinical and community-based setting. I work to evaluate and improve the level of service available to this population.
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.