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Continued Disparities in Postpartum Follow-Up and Screening Among Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy

A Systematic Review

Jones, Emily J., PhD, RNC-OB, FAHA, FPCNA; Hernandez, Teri L., PhD, RN; Edmonds, Joyce K., PhD, MPH, RN; Ferranti, Erin P., PhD, MPH, RN, FAHA

The Journal of Perinatal & Neonatal Nursing: April/June 2019 - Volume 33 - Issue 2 - p 136–148
doi: 10.1097/JPN.0000000000000399
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The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among US women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to black race and Hispanic ethnicity, low level of education, and coexisting morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist versus primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear whether follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population-level data to inform equitable progress to meeting the evidence-informed guidelines.

College of Nursing and Health Sciences, University of Massachusetts Boston (Dr Jones); Department of Medicine, Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, Aurora (Dr Hernandez); College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora (Dr Hernandez); Connell School of Nursing, Boston College, Boston, Massachusetts (Dr Edmonds); and Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Ferranti).

Corresponding Author: Emily J. Jones, PhD, RNC-OB, FAHA, FPCNA, College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125 (Emily.Jones@umb.edu).

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Each author has indicated that he or she has met the journal's requirements for Authorship.

Submitted for publication: December 04, 2018; accepted for publication: January 25, 2019.

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