About half of new moms, including those with diabetes, do not receive critical follow-up care within three months after giving birth, a new study published in the December issue of the journal Contraception shows.
Postpartum care is important for all women, but particularly important for women with diabetes to help ensure blood-sugar control and provide contraception to avoid pregnancy within the recommended 18-month recovery time, said the study authors.
Babies born to diabetic mothers are at higher risk of premature birth, low birth weight and birth defects such as neural tube abnormalities. Previous studies have shown that women with diabetes are more likely to require emergency care during the six months following delivery than those without the disease.
“Rapid repeat pregnancies are much more likely to be complicated for women whose health is already fragile,” said lead author Eleanor Bimla Schwarz, professor of general internal medicine at UC Davis Health. “No one wants to end up in the ICU, let alone have her baby there.”
The current findings were the result of a retrospective study involving claims data from nearly 200,000 women between the ages of 15 and 44 who gave birth while enrolled in Medi-Cal, California’s free or low-cost health care coverage program for low-income individuals.
The researchers compared three groups: those with diabetes prior to pregnancy (preconception diabetes), those with diabetes during pregnancy (gestational diabetes) and those who did not have diabetes. They found that only 55 percent of women with preconception diabetes, 55 percent with gestational diabetes and 48 percent without diabetes had postpartum clinic visits within 99 days of delivery. Of the women who did not have their “tubes tied,” reversible contraception was provided to only 44 percent with preconception diabetes, 43 percent with gestational diabetes and 43 percent without diabetes within 99 days of delivery.
The reasons why women do not receive recommended postpartum care range from lack of knowledge of its importance among both women and clinicians to logistical barriers such as access to transportation and child care, according to Schwarz. She recommends additional research focused on identifying barriers and increasing access to postpartum care.
“Women with diabetes can have healthy pregnancies,” Schwarz said. “They just need to work closely with their providers to make sure they get the care they need.”
The study, titled “Postpartum Care and Contraception provided to Women with Gestational and Preconception Diabetes in California's Medicaid Program,” is available online. It was funded in part by the Centers for Medicare and Medicaid Services 2012 Adult Medicaid Quality Grant to the state of California.
Schwarz’s co-authors were Monica Braughton, Julie Cross Riedel, Mike Howell and Heike Thiel de Bocanegra of UC San Francisco, and Susannah Cohen and Julia Logan of the California Department of Health Care Services. All analyses, interpretations and conclusions are those of the authors, not the state of California.
Information about UC Davis Health and its Department of Internal Medicine is at health.ucdavis.edu.