Missed opportunities for appropriate postpartum care in women with pregestational diabetes

Objective: Our aim was to evaluate postpartum glycemic control in women with pregestational diabetes and to assess contributing factors. Methods: Retrospective data collection from an electronic database on a cohort of Israeli women at Clalit Healthcare Services with pregestational diabetes who gave birth in 2008-2011, including data on HbA_1C, prescription fillings, and socio-demographics. HbA_1C level was assessed during a 2 year time-period, from periconception until one-year postpartum. Results: There were 180 deliveries to 166 women. Compared with the periconception period, the HbA_1C level improved significantly during the last 6 months of pregnancy (6.7% versus 6.0%, p < 0.05). However, there was rapid continuous deterioration in glycemic control in the postpartum period with median HbA_1C = 6.9% in the first 6 months postpartum and 7.2% in the late postpartum period (p < 0.05). One-year postpartum 107 women (59.4%) had suboptimal care (defined as HbA_1C > 7.0% or no test). In the multiple logistic regression analysis, the only significant predictor of 1-year postpartum suboptimal care was suboptimal periconception care, OR = 6.1 (95% CI 3.15-11.84, p = 0.001). Conclusions: Postpartum glycemic control deteriorated rapidly despite excellent control in most women in the last 6 month of pregnancy. More intensive and targeted intervention is needed in order to optimize postpartum care of diabetic patients.