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Health Equity/Community Health

Poster Session 4

(1123) The Value of Extending Maternal Care of Diabetes Mellitus After Delivery in Underserved Areas

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Postpartum care for patients with diabetes mellitus (DM) is challenging for underserved communities. The aim of this study is to compare glycemic control for patients enrolled in a dedicated postpartum care program to those living in other areas of an urban region.

Study Design: This was a prospective cohort study of postpartum individuals with pregestational DM who delivered at a large, safety-net hospital. Patients living within a group of zip codes with identified health disparities are offered enrollment into the extending Maternal Care After Pregnancy (eMCAP) program, which provides management of chronic health conditions including access to a mobile health unit for a year after delivery. Patients living outside the target zip codes receive routine referral to a primary care provider postpartum. Patients in eMCAP with DM were matched 1:2 for maternal age, race/ethnicity, and delivery date to non-eMCAP (control) DM cases. Statistical analysis included Pearson’s chi-square and Student’s t-test. A mixed effects repeated measures regression model was used to compare the change in hemoglobin A1c (HbA1c) over time (a random effect) between cases and controls (a fixed effect).

Results: Between Oct 2020 - Dec 2022, 50 patients with DM were enrolled into eMCAP compared to 100 controls. The majority of eMCAP patients identified as Hispanic (72%) and Black (24%) with mean BMI 37.4 ± 8.5 kg/m2. Patients enrolled in eMCAP had significantly higher rates of follow-up at 3, 6 and 12 months postpartum (all P< 0.01). As a corollary, HbA1c values were significantly lower at 3 and 6 months in patients followed in eMCAP compared to controls, a finding that persisted at 1-year postpartum (P< 0.01, Figure).

Conclusion: Patients with DM enrolled in a dedicated postpartum care program had significantly higher follow-up rates and lower postpartum HbA1c values after delivery. Improving access to postpartum DM care is critical to improve maternal health and reduce future maternal cardiometabolic disease.