Investigating the association between prenatal provider specialty and postpartum glucose testing in people with gestational diabetes: a retrospective analysis of a population-based Canadian cohort.
Date
2024-07-03
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Abstract
Background Gestational diabetes mellitus (GDM) increases future risk of type 2 diabetes and cardiovascular disease. Diabetes Canada guidelines recommend postpartum glucose tolerance testing for everyone with GDM, yet uptake is low. Most evidence of barriers to testing comes from international sources and may not be generalizable to the Canadian perinatal context. Canadian maternity care providers include general practitioners (GPs), obstetricians (OBs), and registered midwives (RMs), with care models that differ from each other and from international providers of the same titles. There is a need for Canadian population-based studies exploring systems-level factors associated with low postpartum screening uptake. Methods We used de-identified population-based data on all births in Alberta, Canada between 2017 and 2018. We identified prenatal care provider specialty, glucose testing incidence, and cohort demographics. The study outcomes were 1) reciept of the gold standard protocol: oral glucose tolerance test (OGTT) within 6 weeks to 6 months, and 2) any glucose test occurring within 6 weeks to 1 year postpartum. We used logistic regression, adjusted for clinically relevant covariates, to estimate an association between test uptake and provider specialty. Results From 105,691 births we identified a GDM cohort of 9,884 eligible births. Cohort proportions of each prenatal care provider were OB (58.6%), GP (38.5%), and RM (2.9%). Overall test incidence was low; 22.2% (95% CI: 21.4 – 23.1) received gold standard testing and 53.9% (95% CI: 52.9 – 54.9) received any testing. When compared to the OB group, people in the GP group were less likely to receive follow-up testing (ORGS= 0.86, 95% CI: 0.77 – 0.95; ORAny= 0.88, 95% CI: 0.81 – 0.96). Those with RM care were also less likely to receive follow-up testing (ORGS= 0.67, 95% CI: 0.46 – 0.96; ORAny= 0.88, 95% CI: 0.67 – 1.15) when compared to the OB group. Discussion The overall proportion of people receiving postpartum glucose testing was low, indicating that efforts to improve screening uptake should be targeted to all care providers.
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Keywords
Gestational diabetes mellitus, Postpartum, Glucose, Prenatal, Midwife, General practitioner, Obstetrician
Citation
Charlong, K. M. (2024). Investigating the association between prenatal provider specialty and postpartum glucose testing in people with gestational diabetes: a retrospective analysis of a population-based Canadian cohort (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.