title: Patterns of preconception, prenatal and postnatal care for diabetic women by obstetrician-gynecologists.
abstract: OBJECTIVE
  To assess barriers to and quality of care received by diabetic pregnant women from obstetrician-gynecologists.
  
  
  METHODS
  A questionnaire was mailed to 1,000 representative practicing Fellows of the American College of Obstetricians and Gynecologists; 74 did not treat pregnant patients and 510 (55.1%) returned completed surveys. Respondents were divided into 3 groups: maternal-fetal medicine specialists, physicians with high minority/low insurance patient populations, and physicians with low minority/ high insurance patient populations.
  
  
  RESULTS
  Reported preconception and prenatal care was generally consistent with guidelines. Regarding gestational diabetes mellitus patients the 3 physician groups differed in assessing postpartum glycemic status, counseling about lifestyle changes, and counseling patients to consult a doctor before their next pregnancy. Patient demographics and perceived barriers to care were similar between maternal-fetal medicine specialists and physicians with high minority/low insurance patient populations. These two physician groups were more likely to agree that lack of educational materials, arranging specialist referrals, patient compliance with recommendations, and patients' ability to afford healthful food were barriers to quality care.
  
  
  CONCLUSIONS
  According to physician self-report, pregnant diabetic patients with access to an obstetrician receive quality care regardless of insurance status. Postpartum care is more variable. Physicians with high minority/low insurance patient populations may lack access to resources.
authors: Department of Research, American College of Obstetricians and Gynecologists, Washington, DC 20024, USA. mpower@acog.org
authors: Michael L
authors: ML
authors: Power
authors: Ellen K
authors: EK
authors: Wilson
authors: Sean O
authors: SO
authors: Hogan
authors: John D
authors: JD
authors: Loft
authors: Jennifer L
authors: JL
authors: Williams
authors: Patricia W
authors: PW
authors: Mersereau
authors: Jay
authors: J
authors: Schulkin
mesh_terms: D001294:Attitude to Health; D001786:Blood Glucose; D001835:Body Weight; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy*; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000628:therapy; D004032:Diet / Q000191:economics; D037001:Directive Counseling; D015444:Exercise; D005260:Female; D019983:Guideline Adherence; D006176:Gynecology / Q000592:standards*; D006801:Humans; D007348:Insurance, Health; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009774:Obstetrics / Q000592:standards*; D010349:Patient Compliance; D010353:Patient Education as Topic; D011181:Postnatal Care / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D016742:Preconception Care / Q000592:standards; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000628:therapy*; D011295:Prenatal Care / Q000592:standards; D012017:Referral and Consultation; D012959:Socioeconomic Factors
chemical_list: D001786:Blood Glucose