title: Postpartum healthcare after gestational diabetes and hypertension.
abstract: BACKGROUND
  Gestational diabetes and hypertensive disorders of pregnancy identify women with an elevated lifetime risk of diabetes and cardiovascular disease.
  
  
  METHODS
  Prospective cohort of women recruited from the postpartum service of a large community-based academic obstetrical hospital after delivery of a pregnancy complicated by gestational diabetes (GDM) or a hypertensive disorder of pregnancy (HDP). Interviews were conducted, and validated surveys completed, before hospital discharge and again 3 months postpartum.
  
  
  RESULTS
  The study sample included 249 women: 111 with GDM, 127 with HDP, and 11 with both. Most, 230 (92.4%) had a PCP prior to pregnancy and 97 (39.0%) reported an office visit with their PCP during the prenatal period. Of the 176 (70.7%) participants who attended the 3-month study visit, 169 (96.0%) women with either diagnosis reported they had attended their 6-week postpartum visit. By the 3-month study visit, 51 (57.9%) women with GDM had completed follow-up glucose testing; 93 (97.9%) with HDP had follow-up blood pressure testing; and 101 (57.4%) with either diagnosis recalled ever having completed lipid screening. Women least likely to complete screening tests were those who had no college education, less than a high school level of health literacy, and who were not privately insured.
  
  
  CONCLUSIONS
  There are important opportunities to improve postpartum testing for diabetes and CVD risk factor assessment. Most women were connected to primary care suggesting a "hand-off" to a primary care physician after pregnancy is feasible. More robust strategies may be needed to improve follow-up care for women with less education, lower health literacy, and those without private health insurance.
authors.affiliation: 1 Department of Obstetrics and Gynecology and the Value Institute, Christiana Care Health System , Newark, Delaware.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Ehrenthal
authors.forename: Kristin
authors.initials: K
authors.lastname: Maiden
authors.forename: Stephanie
authors.initials: S
authors.lastname: Rogers
authors.forename: Amy
authors.initials: A
authors.lastname: Ball
mesh_terms: D000367:Age Factors; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D005951:Glucose Tolerance Test; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D046110:Hypertension, Pregnancy-Induced / Q000175:diagnosis / Q000628:therapy; D007407:Interviews as Topic; D008403:Mass Screening / Q000379:methods*; D011181:Postnatal Care / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D001786:Blood Glucose
references.citation: Hypertension. 2010 Sep;56(3):331-4
references.pmid: 20679178
references.citation: Hypertension. 2008 Apr;51(4):1034-41
references.pmid: 18259037
references.citation: PLoS One. 2012;7(10):e47052
references.pmid: 23071709
references.citation: Obstet Gynecol. 2006 Dec;108(6):1456-62
references.pmid: 17138780
references.citation: Diabetes Care. 2002 Oct;25(10):1862-8
references.pmid: 12351492
references.citation: Evid Rep Technol Assess (Summ). 2004 Jan;(87):1-8
references.pmid: 15819598
references.citation: Womens Health Issues. 2011 Sep-Oct;21(5):338-44
references.pmid: 21703866
references.citation: BMJ. 2002 Jul 20;325(7356):157-60
references.pmid: 12130616
references.citation: BMC Pregnancy Childbirth. 2013 Mar 09;13:61
references.pmid: 23497157
references.citation: Circulation. 2011 Mar 22;123(11):1243-62
references.pmid: 21325087
references.citation: Obstet Gynecol. 2008 Apr;111(4):945-52
references.pmid: 18378755
references.citation: Hypertension. 2003 Mar;41(3):437-45
references.pmid: 12623940
references.citation: MMWR Morb Mortal Wkly Rep. 2012 Sep 7;61:697-702
references.pmid: 22951451
references.citation: Obstet Gynecol. 2009 Nov;114(5):958-960
references.pmid: 20168094
references.citation: J Clin Hypertens (Greenwich). 2007 Jul;9(7):560-6
references.pmid: 17617769
references.citation: Hypertension. 2009 Jun;53(6):944-51
references.pmid: 19433776
references.citation: Prev Chronic Dis. 2011 Nov;8(6):A124
references.pmid: 22005617
references.citation: Nat Clin Pract Endocrinol Metab. 2008 Oct;4(10):552-8
references.pmid: 18779843
references.citation: BMC Fam Pract. 2009 Dec 08;10:77
references.pmid: 19995418
references.citation: Matern Child Health J. 2014 Feb;18(2):366-72
references.pmid: 23397099
references.citation: Lancet. 2009 May 23;373(9677):1773-9
references.pmid: 19465232
references.citation: Curr Opin Cardiol. 2013 Sep;28(5):547-53
references.pmid: 23928919
references.citation: Can Fam Physician. 2010 Jun;56(6):558-63
references.pmid: 20547525
references.citation: Semin Perinatol. 2003 Jun;27(3):239-46
references.pmid: 12889591
references.citation: Clin Cardiol. 2012 Mar;35(3):160-5
references.pmid: 22389120
references.citation: J Obstet Gynaecol Can. 2012 Sep;34(9):836-841
references.pmid: 22971452
references.citation: Int J Gynaecol Obstet. 1988 Aug;27(1):45-9
references.pmid: 2905297
references.citation: Womens Health Issues. 2012 Mar;22(2):e123-8
references.pmid: 22385899
references.citation: Am J Obstet Gynecol. 2013 Jun;208(6):474.e1-8
references.pmid: 23399350
references.citation: Med Care. 2003 Nov;41(11):1284-92
references.pmid: 14583691
references.citation: Diabetes Care. 2003 Feb;26(2):265-8
references.pmid: 12547846
references.citation: Prim Care Diabetes. 2013 Oct;7(3):177-86
references.pmid: 23684416
references.citation: Am J Obstet Gynecol. 2011 Apr;204(4):336.e1-9
references.pmid: 21183153
references.citation: BMJ. 2007 Nov 10;335(7627):974
references.pmid: 17975258