Background:
The National Association of Chronic Disease Directors (NACDD) and CDC's Divisions for Reproductive Health (DRH) and Diabetes Translation are working together on a project to increase collaboration among state PRAMS, (Pregnancy Risk Assessment Monitoring System,) maternal child health (MCH), and chronic disease programs. The new preconception health recommendations emphasize the importance of chronic disease prevention and management of risk factors prior to pregnancy, as well as during pregnancy and postpartum.

Objectives:
To enhance this linkage, six states have formed a collaborative to validate and catalogue gestational diabetes (GDM) prevalence, care, and outcome data sources. States will establish a data base and develop recommendations to enhance preconception and prenatal care for diabetes prevention.

Methods:
As a pilot program for this collaboration, the Utah Department of Health reviewed hospital medical charts of 75 PRAMS respondents where the mother reported having “high blood sugar (diabetes) that started during this pregnancy” but no diagnosis of GDM was noted on the birth certificate to determine the GDM status.

Results:
This review identified several surveillance and care concerns. Almost 40% of the charts reviewed had a GDM diagnosis that was not recorded on the birth certificate. Sixteen percent had no documented GDM testing during pregnancy. Of those women who had an elevated 1-hour glucose tolerance test (GTT) only one-third received a 3-hour GTT. In some cases, test dates, procedures, results, interpretation of results and provider follow-up were missing from the chart. Only three cases had postpartum recommendations for follow-up.


Conclusion and implications for practice:
With such variations in recording diagnoses, testing procedures and care for women with GDM, it is difficult to determine prevalence and quality of care. Studies estimate less than half of women with GDM receive a follow-up GTT postpartum. Women who have had GDM have a 17%-63% risk of developing non-gestational diabetes within 5-16 years after pregnancy Collaboration of state MCH and chronic disease programs is imperative to improve the quality of data collection, prenatal GDM testing and care, and postpartum follow-up to ensure healthy birth outcomes and early prevention of type 2 diabetes. Each postpartum intervention is a preconception benefit for the next pregnancy.