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

J Perinat Neonatal Nurs. 2019 Apr/Jun;33(2):136-148. doi: 10.1097/JPN.0000000000000399.

Abstract

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.

Publication types

  • Systematic Review

MeSH terms

  • Diabetes, Gestational / diagnosis*
  • Diabetes, Gestational / mortality
  • Diabetes, Gestational / therapy
  • Female
  • Follow-Up Studies
  • Healthcare Disparities / economics*
  • Healthcare Disparities / ethnology
  • Humans
  • Hypertension, Pregnancy-Induced / diagnosis*
  • Hypertension, Pregnancy-Induced / mortality
  • Hypertension, Pregnancy-Induced / therapy
  • Mass Screening / standards*
  • Mass Screening / trends
  • Maternal Death / prevention & control*
  • Postnatal Care / methods*
  • Postpartum Period
  • Pregnancy
  • Pregnancy Outcome
  • Pregnancy, High-Risk
  • Risk Assessment