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Obstetric Quality and Safety

Poster Session 2

(501) Comparing the effectiveness of postpartum transition strategies for patients with impaired glucose tolerance (IGT)

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:

Patients with IGT receive less antenatal support compared to patients with gestational or pregestational diabetes but carry long-term metabolic risk. At our institution, 15% repeat glucose testing postpartum and 29% follow up with primary care (PCP). We compared the effectiveness of text messaging support (BRIDGE) to text message support and IGT-focused postpartum visit (BRIDGE+) for care transitions.

Study Design:

Patients with IGT (A1C 5.7-6.4% < 20 weeks gestation) who delivered at a single tertiary care center October 2021-April 2023 were enrolled in BRIDGE, text messaging support with IGT education and follow-up reminders. From July 2022 to April 2023, BRIDGE participants were offered an additional postpartum visit for standardized IGT education (iPPV). Patients were excluded if they were non-English speaking, had gestational or pregestational diabetes, or did not complete third trimester glucose testing.

 

Our dual primary outcomes were A1C completion and scheduled PCP visit by 12 weeks postpartum. Bivariate comparisons assessed demographic and clinical differences. Multivariable regression models with stepwise backward elimination using p >0.20 compared outcomes.

Results:

Characteristics of BRIDGE (n=84) and BRIDGE+ (n=80) participants were similar. 27.4% of patients completed A1C and 45.7% of patients scheduled PCP visit by 12 weeks postpartum. Controlling for scant prenatal care (< 5 visits) and history of IGT prior to pregnancy, BRIDGE+ did not increase A1C completion or PCP visit scheduling rates compared to BRIDGE (Table 1). iPPV attendance was higher than PCP visit attendance (48.9% vs 32.5%, p=0.02). Only 34% of PCP visits included documented IGT education.

Conclusion:

Text message support improved A1C completion and PCP follow-up for patients with IGT relative to our institution’s historic baseline. iPPV did not improve transitions of care compared to text message support alone. iPPV had higher rates of IGT education and visit attendance compared to PCP visits.