title: Missed opportunities for appropriate postpartum care in women with pregestational diabetes.
abstract: OBJECTIVE
  Our aim was to evaluate postpartum glycemic control in women with pregestational diabetes and to assess contributing factors.
  
  
  METHODS
  Retrospective data collection from an electronic database on a cohort of Israeli women at Clalit Healthcare Services with pregestational diabetes who gave birth in 2008-2011, including data on HbA(1C), prescription fillings, and socio-demographics. HbA(1C) level was assessed during a 2 year time-period, from periconception until one-year postpartum.
  
  
  RESULTS
  There were 180 deliveries to 166 women. Compared with the periconception period, the HbA(1C) level improved significantly during the last 6 months of pregnancy (6.7% versus 6.0%, p < 0.05). However, there was rapid continuous deterioration in glycemic control in the postpartum period with median HbA(1C) = 6.9% in the first 6 months postpartum and 7.2% in the late postpartum period (p < 0.05). One-year postpartum 107 women (59.4%) had suboptimal care (defined as HbA(1C) > 7.0% or no test). In the multiple logistic regression analysis, the only significant predictor of 1-year postpartum suboptimal care was suboptimal periconception care, OR = 6.1 (95% CI 3.15-11.84, p = 0.001).
  
  
  CONCLUSIONS
  Postpartum glycemic control deteriorated rapidly despite excellent control in most women in the last 6 month of pregnancy. More intensive and targeted intervention is needed in order to optimize postpartum care of diabetic patients.
authors.affiliation: a Departement of Obstetrics and Gynecology , The Lady Davis Carmel Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology , Haifa and.
authors.forename: Shlomit
authors.initials: S
authors.lastname: Riskin-Mashiah
authors.affiliation: b School of Public Health, Faculty of Health and Social Sciences, University of Haifa , Haifa , Israel.
authors.forename: Ronit
authors.initials: R
authors.lastname: Almog
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D005260:Female; D006801:Humans; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood*; D012189:Retrospective Studies
keywords: Glycemic control; postpartum HbA1C; quality of care; type 1 or 2 diabetes