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Postpartum care and contraception for women with gestational and preconception diabetes mellitus
ABSTRACTS / Contraception 92 (2015) 359–414 Objectives: We aimed to quantify and evaluate the impact of unintended pregnancy on health-related quality of life, an increasingly important patient-centered outcome. Methods: English- or Spanish-speaking women aged 15–44 with newly positive pregnancy tests who were less than 20 weeks' gestation completed self-assessments of pregnancy happiness, desirability, timing, intention, wantedness and planning using the six-item London Measure of Unplanned Pregnancy (LMUP). Self-assessments were compared with Patient Reported Outcomes Measurement Information System Global Short Form mean T-scores for mental and physical health-related quality of life using multivariable logistic regression to adjust for age, education, marital status, race/ ethnicity, language, gestational age, parity and employment. Results: We enrolled 87 participants from June 2014 through January 2015. Most were Hispanic (58%) or Black (34%); 43% were Spanish speaking. Participants were young (mean age 26.5), 79% were unmarried and 82% already had a child. Mean gestational age was 8 weeks (4–19 weeks; SD, 3 weeks). In multivariate models, low mental health-related quality of life was more common among women who felt unhappy after learning of pregnancy (15%; OR, 4.74; 95% CI, 1.08–20.70), described the pregnancy as not “desired” (22%; OR, 4.76; 95% CI, 1.36– 16.62) or said the timing was not “right” (45%; OR, 2.69; 95% CI, 1.01–7.19). Low physical health-related quality of life was significantly associated only with reporting that pregnancy timing was not “right” (44%; OR, 3.74; 95% CI, 1.35–10.32). Outcomes: Although much research has focused on pregnancy intention, other self-assessments of pregnancy context, including happiness, desirability and timing, appear more predictive of health-related quality of life. http://dx.doi.org/10.1016/j.contraception.2015.06.147
P98
Albert Einstein College of Medicine, Bronx, NY, USA Levi E, J Garrett JM Objectives: This study sought to measure the incidence of postpartum visit nonattendance and identify predictors. In addition, we measured the association between nonattendance and rapid repeat pregnancy. Methods: This retrospective cohort study included all women (N= 6489) who delivered live births at a Montefiore hospital in 2013. Patient demographic characteristics, insurance and delivery information were abstracted from medical records, and multivariable logistic regression was used to analyze association with nonattendance at a follow-up visit within 12 weeks postpartum. We also analyzed an additional cohort of women (N= 6378) who delivered in 2012 and had another delivery within 18 months to determine the association between postpartum visit nonattendance and rapid repeat pregnancy. Results: Among women who had a birth in 2013, 43% did not attend a postpartum visit. Variables significantly associated with nonattendance included no prenatal care at Montefiore (OR, 47.8; 95% CI, 38.8–59.5), low socioeconomic status (OR, 1.4; 95% CI, 1.1–1.7), Medicaid or no insurance (OR, 1.5; 95% CI, 1.3–1.7), vaginal delivery (OR, 1.5; 95% CI, 1.3–1.7) and being younger than 20 versus being older than 30 (OR, 1.5; 95% CI, 1.1–1.9). Among women who gave birth in 2012, visit nonattendance was significantly associated with a subsequent birth within 18 months postpartum (OR, 1.7; 95% CI, 1.3–2.2). Outcomes: The rate of postpartum visit nonattendance is higher than previously estimated and disproportionately affects economically disadvantaged women. Contraception initiation during admission for delivery may decrease rates of rapid repeat pregnancy among these patients.
Postpartum care and contraception for women with gestational and preconception diabetes mellitus
http://dx.doi.org/10.1016/j.contraception.2015.06.149
Schwarz EB University of California, Davis, Sacramento, CA, USA
P100
Barr M, Cross Riedel J, Howell M, Thiel de Bocanegra H Objectives: We aimed to assess receipt of postpartum care and contraception among women with diabetes. Methods: We conducted a retrospective cohort study of 199,860 low-income women aged 15–44, who were continuously enrolled in Medi-Cal from 43 days before delivery to 99 days after delivery in California in 2012. We used logistic regression to examine whether diabetes significantly affects rates of postpartum visits and contraceptive provision, after controlling for maternal age, race/ethnicity, primary language, cesarean delivery, residence in a primary care shortage area and state health care funding program. Results: Among the study cohort of 17,970 women with gestational diabetes, 11,494 women with preconception diabetes, and 170,396 nondiabetic women, nearly half had no documented postpartum care or receipt of contraception. Rates of postpartum care (55% preconception vs. 55.3% gestational vs. 48.4% no diabetes, pb.0001) and receipt of contraception (52% preconception vs. 50% gestational vs. 47% no diabetes, pb.0001) were somewhat higher among diabetic women than nondiabetic women, primarily because postpartum sterilization was highest among diabetic women (14.1% preconception vs. 10.3% gestational vs. 6.1% no diabetes, pb.0001). Among women who did not undergo sterilization, receipt of an IUD or implant was slightly more common among those who had gestational diabetes (10.8%; AOR, 1.13; 95% CI, 1.08–1.20) but not among preconception diabetics (9.3%; AOR, 1.01; 95% CI, 0.94–1.09) compared with nondiabetic women (10.2%). Outcomes: Many women whose pregnancy was affected by diabetes do not have recommended postpartum care documented. Increasing postpartum contraception, especially use of IUDs and subdermal contraception, may help more women achieve glycemic control prior to a subsequent pregnancy. http://dx.doi.org/10.1016/j.contraception.2015.06.148
P99
“Nuestras Historias, Nuestras Opciones”: understanding barriers to postpartum family planning among uninsured Latinas using a community-based participatory research approach Mehta P University of Pennsylvania, Philadelphia, PA, USA Kraybill A, Aparicio J, Zamora I, Barg F, Ludmir J, Schreiber CA Objectives: We sought to ascertain the postpartum family planning needs of uninsured Latinas using a network of promotoras, or community health workers, embedded in this community in Philadelphia. Methods: We conducted qualitative, semistructured interviews with a purposive sample of currently and recently pregnant uninsured Latina women recruited by a network of promotoras. An interview guide was developed using the integrated behavioral model, a conceptual framework for understanding why a person does or does not perform a given behavior. Questions explored postpartum family planning goals, intentions, beliefs, barriers and facilitators. Interviews were transcribed, de-identified and coded by two independent coders using NVivo 10.0. We used a modified grounded theory approach for the analysis. Results: Thirty women were interviewed. The majority articulated clear family planning goals and perceived that achieving these goals was within their power. However, partner influence, cost and limited health system access due to immigration status were identified as key obstacles to postpartum method use. Social support and affordability were identified as facilitators of method use. Outcomes: The integrated model of behavior was a useful conceptual model for understanding pregnancy-related behaviors in our immigrant population. Uninsured pregnant and postpartum women articulated clear family planning goals and self-efficacy, but behaviors were constrained by partner and system dynamics; future interventions can focus on optimizing facilitators and addressing these constraints.
Predictors of non-attendance at the postpartum follow-up visit Wilcox A
391
http://dx.doi.org/10.1016/j.contraception.2015.06.150
P98
Albert Einstein College of Medicine, Bronx, NY, USA Levi E, J Garrett JM Objectives: This study sought to measure the incidence of postpartum visit nonattendance and identify predictors. In addition, we measured the association between nonattendance and rapid repeat pregnancy. Methods: This retrospective cohort study included all women (N= 6489) who delivered live births at a Montefiore hospital in 2013. Patient demographic characteristics, insurance and delivery information were abstracted from medical records, and multivariable logistic regression was used to analyze association with nonattendance at a follow-up visit within 12 weeks postpartum. We also analyzed an additional cohort of women (N= 6378) who delivered in 2012 and had another delivery within 18 months to determine the association between postpartum visit nonattendance and rapid repeat pregnancy. Results: Among women who had a birth in 2013, 43% did not attend a postpartum visit. Variables significantly associated with nonattendance included no prenatal care at Montefiore (OR, 47.8; 95% CI, 38.8–59.5), low socioeconomic status (OR, 1.4; 95% CI, 1.1–1.7), Medicaid or no insurance (OR, 1.5; 95% CI, 1.3–1.7), vaginal delivery (OR, 1.5; 95% CI, 1.3–1.7) and being younger than 20 versus being older than 30 (OR, 1.5; 95% CI, 1.1–1.9). Among women who gave birth in 2012, visit nonattendance was significantly associated with a subsequent birth within 18 months postpartum (OR, 1.7; 95% CI, 1.3–2.2). Outcomes: The rate of postpartum visit nonattendance is higher than previously estimated and disproportionately affects economically disadvantaged women. Contraception initiation during admission for delivery may decrease rates of rapid repeat pregnancy among these patients.
Postpartum care and contraception for women with gestational and preconception diabetes mellitus
http://dx.doi.org/10.1016/j.contraception.2015.06.149
Schwarz EB University of California, Davis, Sacramento, CA, USA
P100
Barr M, Cross Riedel J, Howell M, Thiel de Bocanegra H Objectives: We aimed to assess receipt of postpartum care and contraception among women with diabetes. Methods: We conducted a retrospective cohort study of 199,860 low-income women aged 15–44, who were continuously enrolled in Medi-Cal from 43 days before delivery to 99 days after delivery in California in 2012. We used logistic regression to examine whether diabetes significantly affects rates of postpartum visits and contraceptive provision, after controlling for maternal age, race/ethnicity, primary language, cesarean delivery, residence in a primary care shortage area and state health care funding program. Results: Among the study cohort of 17,970 women with gestational diabetes, 11,494 women with preconception diabetes, and 170,396 nondiabetic women, nearly half had no documented postpartum care or receipt of contraception. Rates of postpartum care (55% preconception vs. 55.3% gestational vs. 48.4% no diabetes, pb.0001) and receipt of contraception (52% preconception vs. 50% gestational vs. 47% no diabetes, pb.0001) were somewhat higher among diabetic women than nondiabetic women, primarily because postpartum sterilization was highest among diabetic women (14.1% preconception vs. 10.3% gestational vs. 6.1% no diabetes, pb.0001). Among women who did not undergo sterilization, receipt of an IUD or implant was slightly more common among those who had gestational diabetes (10.8%; AOR, 1.13; 95% CI, 1.08–1.20) but not among preconception diabetics (9.3%; AOR, 1.01; 95% CI, 0.94–1.09) compared with nondiabetic women (10.2%). Outcomes: Many women whose pregnancy was affected by diabetes do not have recommended postpartum care documented. Increasing postpartum contraception, especially use of IUDs and subdermal contraception, may help more women achieve glycemic control prior to a subsequent pregnancy. http://dx.doi.org/10.1016/j.contraception.2015.06.148
P99
“Nuestras Historias, Nuestras Opciones”: understanding barriers to postpartum family planning among uninsured Latinas using a community-based participatory research approach Mehta P University of Pennsylvania, Philadelphia, PA, USA Kraybill A, Aparicio J, Zamora I, Barg F, Ludmir J, Schreiber CA Objectives: We sought to ascertain the postpartum family planning needs of uninsured Latinas using a network of promotoras, or community health workers, embedded in this community in Philadelphia. Methods: We conducted qualitative, semistructured interviews with a purposive sample of currently and recently pregnant uninsured Latina women recruited by a network of promotoras. An interview guide was developed using the integrated behavioral model, a conceptual framework for understanding why a person does or does not perform a given behavior. Questions explored postpartum family planning goals, intentions, beliefs, barriers and facilitators. Interviews were transcribed, de-identified and coded by two independent coders using NVivo 10.0. We used a modified grounded theory approach for the analysis. Results: Thirty women were interviewed. The majority articulated clear family planning goals and perceived that achieving these goals was within their power. However, partner influence, cost and limited health system access due to immigration status were identified as key obstacles to postpartum method use. Social support and affordability were identified as facilitators of method use. Outcomes: The integrated model of behavior was a useful conceptual model for understanding pregnancy-related behaviors in our immigrant population. Uninsured pregnant and postpartum women articulated clear family planning goals and self-efficacy, but behaviors were constrained by partner and system dynamics; future interventions can focus on optimizing facilitators and addressing these constraints.
Predictors of non-attendance at the postpartum follow-up visit Wilcox A
391
http://dx.doi.org/10.1016/j.contraception.2015.06.150