Schwarz Eleanor Bimla, Braughton Monica Y, Riedel Julie Cross, Cohen Susannah, Logan Julia, Howell Mike, Thiel de Bocanegra Heike
University of California, Davis, Department of Medicine, Sacramento, CA, USA.
University of California, San Francisco, Department of Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, CA, USA.
Contraception. 2017 Dec;96(6):432-438. doi: 10.1016/j.contraception.2017.08.006. Epub 2017 Aug 24.
To compare rates of postpartum care and contraception provided to women with gestational or preconception diabetes mellitus to women with no known diabetes mellitus.
A retrospective cohort study of 199,860 women aged 15-44 years who were continuously enrolled in California's Medicaid program, Medi-Cal, from 43 days prior to 99 days after delivering in 2012. Claims for postpartum clinic visits and contraceptive supplies were compared for 11,494 mothers with preconception diabetes, 17,970 mothers with gestational diabetes, and 170,396 mothers without diabetes. Multivariable logistic regression was used to control for maternal age, race/ethnicity, primary language, residence in a primary care shortage area, state-funded healthcare program and Cesarean delivery, when examining the effects of diabetes on postpartum care and contraception.
Although postpartum clinic visits were more common with diabetes (55% preconception, 55% gestational, 48% no diabetes, p=<.0001), almost half did not receive any postpartum care within 99 days of delivery. Women with pregnancies complicated by diabetes were more likely to receive permanent contraception than women without diabetes (preconception diabetes, aOR: 1.39, 95% CI: 1.31-1.47; gestational diabetes, aOR: 1.20, 95% CI: 1.14-1.27). However, among women without permanent contraception, less than half received any reversible contraception within 99 days of delivery (44% preconception, 43% gestational, 43% no diabetes) and less effective, barrier contraceptives were more commonly provided to women with preconception diabetes than women without diabetes (aOR: 1.24, 95% CI:1.16-1.33).
Low-income Californian women with pregnancies complicated by diabetes do not consistently receive postpartum care or contraception that may prevent complication of future pregnancies.
Efforts are needed to improve rates of provision of postpartum care and high quality contraceptive services to low income women in California, particularly following pregnancies complicated by diabetes.
比较为患有妊娠期糖尿病或孕前糖尿病的女性提供产后护理和避孕措施的比率与未患糖尿病女性的比率。
一项回顾性队列研究，研究对象为199,860名年龄在15 - 44岁之间的女性，她们在2012年分娩前43天至分娩后99天期间持续参加加利福尼亚州的医疗补助计划（Medi - Cal）。比较了11,494名孕前糖尿病母亲、17,970名妊娠期糖尿病母亲和170,396名无糖尿病母亲的产后诊所就诊和避孕用品申领情况。在研究糖尿病对产后护理和避孕的影响时，使用多变量逻辑回归来控制产妇年龄、种族/族裔、主要语言、居住在初级保健短缺地区、国家资助的医疗保健计划以及剖宫产情况。
尽管糖尿病患者产后诊所就诊更为常见（孕前糖尿病患者为55%，妊娠期糖尿病患者为55%，无糖尿病患者为48%，p <.0001），但几乎一半的患者在分娩后99天内未接受任何产后护理。与无糖尿病的女性相比，患有糖尿病妊娠并发症的女性更有可能接受永久性避孕措施（孕前糖尿病，调整后比值比：1.39，95%置信区间：1.31 - 1.47；妊娠期糖尿病，调整后比值比：1.20，95%置信区间：1.14 - 1.27）。然而，在未采取永久性避孕措施的女性中，不到一半的人在分娩后99天内接受了任何可逆性避孕措施（孕前糖尿病患者为44%，妊娠期糖尿病患者为43%，无糖尿病患者为43%），并且与无糖尿病的女性相比，孕前糖尿病女性更常获得效果较差的屏障避孕措施（调整后比值比：1.24，95%置信区间：1.16 - 1.33）。
患有糖尿病妊娠并发症的加利福尼亚州低收入女性未能始终如一地获得可预防未来妊娠并发症的产后护理或避孕措施。
需要努力提高加利福尼亚州低收入女性，尤其是患有糖尿病妊娠并发症后的产后护理和高质量避孕服务的提供比率。
