Gestational Diabetes: Partnerships for Improving Care

Objective: To document continuity of care during and post pregnancy for women with gestational diabetes, develop recommendations for policies and practices to improve data systems and care, and to promote collaboration and innovation among internal and external partners.

Methods: A tribal health system, a national organization, federal and state diabetes and maternal and child health programs collaborated to validate screening for gestational diabetes in pregnant women and the follow-up diabetes care received at a tribal health system.

Results: Of the 101 pregnant women, 95.2% had documented GDM testing, diagnosis, follow-up and education.  Women with abnormal screens received gestational diabetes care from a multi-disciplinary team at the Comprehensive Diabetes Center. Women with multiple risk factors had little documented follow-up or postpartum referrals for overweight or glucose issues. A quality improvement strategy session was convened among the partners with a resultant action plan to be implemented by all partners.

Conclusion: Evidence demonstrates women having had GDM are 7.4 times more likely to develop type 2 diabetes than women without GMD.  Identification, education and long-term follow-up with lifestyle modification can prevent or delay type 2 DM onset.  Our data suggest women with GDM:

• May not receive adequate education and follow-up and or  understand their risk for type 2 diabetes
• May not receive appropriate follow-up postpartum to minimize conversion to type 2 DM, or receive interventions for weight management, physical activity
• Improved policies, best practices and innovative strategies can be developed to promote and protect the health of women during the child-bearing years