589: Evaluation of adherence to early diabetes screening during pregnancy

Abstract

To evaluate adherence to early diabetes mellitus (DM) screening in pregnancy; to assess pregnancy outcomes associated with adherence to guidelines. Retrospective cohort study of women with singleton gestations who received prenatal care at a tertiary care center (2012-14). Women who were eligible for early DM screening by American Diabetes Association (ADA) or American College of Obstetricians and Gynecologists (ACOG) criteria and who presented for prenatal care prior to 21w0d were included. Early screening was defined as DM screening prior to 21w0d, regardless of testing strategy. Medical records were queried for pregnancy outcomes. The frequency with which eligible women received early screening was calculated on a monthly basis and plotted on a run chart. Bivariable analysis identified patient factors associated with adherence. Pregnancy outcomes were compared between women who appropriately had early screening vs. those who were missed using multivariable regression. Of 2,069 women receiving care in the study period, 866 (41.9%) were eligible for early diabetes screening by ADA guidelines and comprised the study population. The majority (N=697, 80.5%) did not receive early DM screening despite eligibility. There was a significant decline in adherence over the study period; specifically, frequency of adherence was below the median for four consecutive time points (Figure). On bivariable analysis, women who were appropriately screened were significantly more likely to be younger, multiparous, and of minority race/ethnicity (p< 0.001). They also were more likely to be obese and publicly insured (p< 0.001). In multivariable analysis of pregnancy outcomes, women who were appropriately screened early in pregnancy were more likely to be diagnosed with GDM (aOR 2.13, 95% CI 1.20 to 3.79) prior to delivery. In this high volume tertiary care center, adherence to early diabetes screening guidelines did not successfully occur for the majority of eligible patients. Increased effort to offer provider support and education for early screening is necessary.View Large Image Figure ViewerDownload Hi-res image Download (PPT)