Online Program

Diabetes in pregnancy: The other silent killer

Wednesday, November 4, 2015 : 1:00 p.m. - 1:15 p.m.

Anne Lise Musselman, RN, BSN, MA, Maternal and Child Health Department, Marion County Public Health Department, Indianapolis, IN
Charles William Allen, MD, Action Health Center, Indianapolis, IN
Teri Conard, RN, BSN, MN, Maternal and Child Health Department, Marion County Public Health Department, Indianapolis, IN
Yvonne Beasley, RN, MN, Maternal and Child Health Department, Marion County Public Health Department, Indianapolis, IN
background: The Indianapolis Healthy Babies-Fetal Infant Mortality Review (IHB-FIMR) is a quality improvement program aimed at identifying social and environmental factors contributing to fetal and infant death in Marion County, Indiana. IHB-FIMR has consistently identified maternal diabetes as a contributing factor to fetal and infant death, and more specifically deaths attributed to congenital anomalies. Poor birth outcomes related to diabetes in pregnancy disproportionately affect underserved women and ethnic minorities in Marion County. IHB-FIMR findings are described with an emphasis on implications for future public health research, interventions, and policy development.

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
Program planning
Public health or related public policy

Learning Objectives:
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

Presenting author's disclosure statement:

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.