Date of Award

2010

Document Type

Campus Access Dissertation

Department

Health Services and Policy Management

First Advisor

Janice C. Probst

Abstract

Gestational Diabetes Mellitus (GDM) is a complicated medical condition that can have a tremendous impact on infant and maternal health. This study examined aspects of both prenatal and postnatal care for women with GDM. Study one focused on examining the impact of prenatal care on LGA/Macrosomia outcomes by gestational diabetes status among a retrospective cohort of singleton live births to South Carolina women (2004-2007). Results indicate women with GDM were more likely to have an LGA (90th) infant compared to women without GDM, regardless of the level of prenatal care. When compared to a reference population the likelihood of a women with GDM having a LGA (90th) infant was proportionally lower as the level of prenatal care moved from Inadequate (OR=2.11, CI=1.82-2.44) to Intermediate/Adequate (OR=1.52, CI=1.35-1.71). Similar patterns were also noted for LGA (95th) and macrosomia outcomes. Although higher levels of prenatal care did not completely negate the increased likelihood of experiencing an excessive fetal growth outcome among women with GDM, it does appear to reduce the likelihood of excessive fetal growth outcomes when compared to the reference population. Study two focused on examining postpartum screening for diabetes within the ACOG recommended time period of 6-12 weeks postpartum among a retrospective cohort of Medicaid eligible women with GDM (2004-2007). This study utilized linked datasets consisting of birth certificates, hospital discharge and Medicaid claims. Results from this study demonstrate the overall rate of screening for diabetes within the ACOG recommended time period among women with GDM is very low, with only 2.5% of women being screened for diabetes. Adjusted analysis found attending a postpartum visit by week 13, age, pre-pregnancy obesity, and participation in diabetes education to be associated with postpartum screening. Most women qualifying for Medicaid during pregnancy lose coverage 60 days postpartum, leaving a narrow window of opportunity for receipt of postpartum screening for diabetes within the ACOG recommend time period of 6-12 weeks. Extended periods of coverage may be beneficial in assuring women with GDM receive adequate postpartum care, including screening for diabetes.

Rights

© 2010, Nathan Lee Hale

Download

Share

COinS