Poster Session 4
ALISSA PRIOR, MD (she/her/hers)
Maternal Fetal Medicine Fellow
The Metrohealth System/Case Western Reserve University Program
Cleveland, Ohio, United States
Lea Almahameed, BA
Undergraduate Student
The Metrohealth System, Ohio, United States
Megan Weatherborn, MD
Maternal Fetal Medicine Assistant Professor
UMass Chan Medical School - Baystate
Springfield, Massachusetts, United States
Christopher Nau, MD
Maternal Fetal Medicine Assistant Professor
University Hospitals Cleveland Medical Center
Cleveland, Ohio, United States
Coordination of postpartum care for patients with pregestational diabetes mellitus (PDM), including timely diabetes follow-up, is imperative for their long-term health. At our institution, only 21% of patients have a postpartum diabetic care visit in the first 6 months postpartum. A maternal comorbidity index (CMI), a published score to summarize the severity of maternal illness, is a tool to identify high risk pregnant parturients (Table 1). In a cohort of patients with PDM, our objective was to compare a patient’s CMI and postpartum outcomes. We predict a higher CMI would be associated with suboptimal glycemic control and follow up.
Study Design:
This is a retrospective cohort study at a single urban hospital of patients with PDM who attended the center’s diabetes in pregnancy clinic from 2009-2018. Patients who delivered at an outside institution were excluded. Our independent variable was the CMI, dichotomized into low (score 1-4) vs high (score ≥5) groups. The primary outcome was attendance of a diabetes care visit, with Primary Care or Endocrinology, in the 1st year postpartum. Secondary outcomes included postpartum HbA1c, contraception, breastfeeding, and a short-interval pregnancy. Outcome data was analyzed with Fisher’s exact, Wilcoxon rank sum, and Pearson’s Chi-squared tests.
Results:
There were 469 patients included; CMI scores ranged from 1-12 with 346 and 123 patients in the low and high groups, respectively. Baseline demographics, diabetes severity and type, and pregnancy outcomes were similar between groups. Attendance rates of a diabetes care visit were similar, with 51% in the low and 52% in the high CMI group (p >0.9). HbA1c median values were 7.30 in the low vs 7.85 in the high CMI group (p=0.2). All other study outcomes were similar between groups (Table 2).
Conclusion:
Maternal CMI was not associated with differing rates of HbA1c or follow up in patients with PDM up to 12 months postpartum. Only 50% of patients had a diabetes visit in the 1st year postpartum. Further research is needed to identify patients at highest risk of poor follow up.
