UL1 Pilot Award - Gestational Diabetes Aftercare and Postpartum Screening (GAPS) Study

Gestational diabetes mellitus (GDM), defined as carbohydrate intolerance first diagnosed during pregnancy, is one of the most common medical complications of pregnancy. GDM affects approximately 200,000 births each year in the U.S. with an increasing prevalence.1 Women with a history of GDM have a sevenfold higher risk for developing Type 2 Diabetes (T2DM) compared to women without GDM and double the risk of developing cardiovascular disease. Because of these risks, the American Diabetes Association (ADA) recommends an oral glucose tolerance test (OGTT) at 4-12 weeks postpartum for every women with GDM.2 For those with a normal OGTT result, ongoing screening for prediabetes or tT2DM is recommended every 1–3 years following birth, while referral for preventive or medical therapy should be made for those with impaired T2DM screening results.3 The American College of Obstetricians and Gynecologists (ACOG) also recommend that all women with GDM should follow up with a primary care provider.4 Additionally, ACOG recommends that all postpartum women receive an assessment of mood and emotional wellbeing, which includes formal screening for depression and anxiety, during a comprehensive postpartum visit.5 This is particularly important for women with a history of GDM as they are 2-4 times more likely to develop perinatal depression compared to those without GDM.6-8 Despite these risks and recommendations, receipt of comprehensive postpartum care is lacking, with at least 1 in 4 women receiving no postpartum care,3, 9 and only half of women with a history of GDM being screened for T2DM postpartum.10, 11 There is limited research on screening 1-3 years postpartum or primary care referral. Calls have been made to increase the quality and quantity of postpartum care,12 particularly for women with a history of GDM and other pregnancy complications, but research is needed to understand the barriers to care in this population. The proposed study will address this gap by: 1) conducting chart reviews to assess rates and factors associated with postpartum mental health and T2DM screenings during the postpartum year and for up to 3 years postpartum as well as follow-up utilization in primary care; 2) conducting interviews with women who did and did not receive postpartum care to understand barriers and facilitators to screening; and 3) conducting surveys of healthcare providers involved in postpartum/follow-up care of women with GDM to assess their attitudes and perceived barriers/facilitators to the optimal care of this population. This translational project aims to bridge the gap between the established care guidelines and optimal delivery of this care. Findings from this study can be translated to women with other high-risk pregnancy complications, such as women with hypertensive disorders of pregnancy who are also at increased risk for life long cardiometabolic disease. Additionally, findings may help to optimize postpartum care for all women, as ACOG recommends a shift in care from a single encounter to an ongoing process with services and support tailored to each woman’s individual needs.12