GEAR Groups-wrong

 

Landmark and Archived Articles 

Prevention, Screening and Diagnosis Articles

Care and Treatment Articles

Postpartum Care Articles

Reimbursement and Economic Impact Articles

Public Health, Population Health and Health Equity Articles

 

Landmark and Archived Articles

Do postal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus? A randomized controlled trial. Heather D. Clark, MD, MSc; Ian D. Graham, PhD; Alan Karovitch, MD, MEd; Erin J. Keely, MD. American Journal of Obstetrics & Gynecology, June 2009  

OBJECTIVE: Women with previous gestational diabetes mellitus rarely receive the recommended 2-hour oral glucose tolerance test (OGTT) after delivery. We sought to determine whether postal reminders to be sent after delivery to a patient, her physician, or both would increase screening rates. 
STUDY DESIGN: Patients were assigned randomly to 4 groups: reminders sent to both physician and patient, to physician but not patient, or to patient but not physician or no reminders were sent. The primary outcome was the proportion of patients who underwent an OGTT within 1 year after delivery. The secondary outcome was the performance of other postpartum screening tests.
RESULTS: OGTT rates were significantly increased in the physician/patient reminder group (49/81 women; 60.5%), in the patient-only reminder group (42/76 women; 55.3%), and in the physician-only reminder group (16/31 women; 51.6%) compared with the no reminder group (5/35 women; 14.3%; P.05).
CONCLUSION: Postpartum reminders greatly increased screening rates for women with gestational diabetes mellitus

Gestational Diabetes Mellitus and Postpartum Care Practices of Nurse-Midwives Jean Y. Ko, PhD, Patricia M. Dietz, DrPH, Elizabeth J. Conrey, RD, PhD, Loren Rodgers, PhD, Cynthia Shellhaas, MD, MPH, Sherry L. Farr, PhD, Cheryl L. Robbins.Journal of Midwifery & Women’s Health   J Midwifery Womens Health. 2013 Jan-Feb;58(1):33-40. 

Introduction: Postpartum screening for glucose intolerance among women with recent histories of gestational diabetes mellitus (GDM) is important for identifying women with continued glucose intolerance after birth, yet screening rates are suboptimal. In a thorough review of the literature, we found no studies of screening practices among certified nurse-midwives (CNMs). The objectives of our study were to estimate the prevalence of postpartum screening for abnormal glucose tolerance and related care by CNMs for women with recent histories of GDM and to identify strategies for improvement.
Methods: From October through December 2010, the Ohio Department of Health sent a survey by mail and Internet to all licensed CNMs practicing in Ohio. We calculated prevalence estimates for knowledge, attitudes, clinical practices, and behaviors related to postpartum diabetes screening. Chi-square statistics were used to assess differences in self-reported clinical behaviors by frequency of postpartum screening.
Results: Of the 146 CNMs who provided postpartum care and responded to the survey (62.2% response rate), 50.4% reported screening women with GDM-affected pregnancies for abnormal glucose tolerance at the postpartum visit. Of CNMs who screened postpartum, only 48.4% used fasting blood sugar or the 2-hour oral glucose tolerance test. Although 86.2% of all responding CNMs reported that they inform women with recent histories of GDM of their increased risk for type 2 diabetes mellitus, only 63.1% counseled these women to exercise regularly and 23.3% reported referring overweight/obese women to a diet support group or other nutrition counseling. CNMs reported that identification of community resources for lifestyle interventions and additional training in postpartum screening guidelines may help to improve postpartum care.
Discussion: CNMs in Ohio reported suboptimal levels of postpartum diabetes testing and use of a recommended postpartum test. Providing CNMs with additional training and identifying community resources to support needed lifestyle behavior change may improve care for women with recent GDM-affected pregnancies

A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes Kimberly K. Vesco, MD, MPH; Patricia M. Dietz, DrPH, MPH; Joanna Bulkley, PhD; F. Carol Bruce, BSN, MPH; William M. Callaghan, MD, MPH; Lucinda England, MD, MSPH; Terry Kimes, MS; Donald J. Bachman, MS; Karen J. Hartinger, RN; Mark C. Hornbrook, PhD. Am J Obstet Gynecol 2012;207:283.e1-6.

OBJECTIVE: We sought to determine whether our process improvement program led to increased postpartum diabetes screening rates among women with gestational diabetes mellitus (GDM).
STUDY DESIGN: In early 2009, we conducted obstetrics department staff education sessions, revised GDM patient care protocols, and developed an electronic system to trigger reminder calls to patients who had not completed diabetes mellitus screening by 3 months postpartum. We then evaluated the rates of postpartum glucose test order entry and completion for women with GDM delivering from July 2009 through June 2010 (n 179) and July 2007 through June 2008 (n 200).
RESULTS: After the program’s implementation, the proportion of women receiving an order for a postpartum glucose test within 3 months of delivery increased from 77.5-88.8% (P .004), and test completion increased from 59.5-71.5% (hazard ratio, 1.37; 95% confidence interval, 1.07–1.75). 
CONCLUSION: Rates of postpartum diabetes testing can be improved with system changes and reminders. 

The effectiveness of implementing a reminder system into routine clinical practice: does it increase postpartum screening in women with gestational diabetes?
 A.K. Shea, PhD, MSc; B.R. Shah, MD, PhD; H.D. Clark, MD, MSc; J. Malcolm, MD; M. Walker, MD, MSc; A. Karovitch, MD, MEd; E.J. Keely, MD  Vol 31, No 2, March 2011 – Chronic Diseases in Canada

Introduction: During regular care, women with previous gestational diabetes mellitus (GDM) rarely receive the recommended screening test for type 2 diabetes, a 2-hour oral glucose tolerance test (OGTT), in the postpartum period. The current study examined whether the implementation of a reminder system improved screening rates. 
Methods: Based on our previous randomized control trial, we implemented a postpartum reminder (letter or phone call) protocol into routine care at two of three clinical sites. We verified postpartum testing by searching hospital laboratory databases and by linking to the provincial physician service claims database. The primary outcome was the proportion of patients who underwent an OGTT within 6 months of delivery. 
Results: Women who received care in a setting using a reminder system were more likely to receive an OGTT within 6 months postpartum (28%) compared with usual care (14%). The OGTT rates for both reminder groups were lower than that found in our randomized control trial (28% vs. 60%). 
Conclusion: Although the screening rates remain low, postpartum reminders doubled screening rates using the recommended test, the OGT.

Patient counseling increases postpartum follow-up in women with gestational diabetes mellitus. Marina Stasenko, BA; Jennifer Liddell, RN, CDE; Yvonne W. Cheng, MD, MPH; Teresa N. Sparks, MD; Molly Killion, RN; Aaron B. Caughey, MD, PhD American  Journal of Obstetrics & Gynecology JUNE 2011 

OBJECTIVE: The objective of the study was to evaluate the efficacy of an educational intervention at increasing the rates of postpartum (PP) follow-up for women with gestational diabetes mellitus (GDM). 
STUDY DESIGN: A retrospective cohort study of all patients with GDM delivering during 2002-2009 was conducted. The primary outcome was obtaining PP diabetes testing. The 2002-2006 cohort was advised to obtain PP testing by their providers. The 2007-2009 cohort received educational counseling at the 37-38 week visit by a nurse educator. Univariate and multivariable statistical tests were utilized.
RESULTS: The PP testing frequency was 53% for the 2007-2009 cohort, compared with 33% for the 2002-2006 cohort (PI.001). When stratified by race/ethnicity, increased rates of testing were seen in whites (28% to 53%, PI.001), Latinas (15% to 50%, PI .001), and Asians (43% to 59%, PI .005). There was a nonsignificant decrease in the African American follow-up, 28% to 17% (PI .414).
CONCLUSION: GDM precedes the development of type 2 diabetes. Antepartum education counseling increases postpartum diabetes testing. More efforts are needed to obtain universal screening.

Physician Care Patterns and Adherence to Postpartum Glucose Testing after Gestational Diabetes Mellitus in Oregon. Monica L. Hunsberger, Rebecca J. Donatelle, Karen Lindsay, Kenneth D. Rosenberg. PLoS ONE 7(10): e47052. doi:10.1371/journal.pone.0047052 

Objective: This study examines obstetrician/gynecologists and family medicine physicians’ reported care patterns, attitudes and beliefs and predictors of adherence to postpartum testing in women with a history of gestational diabetes mellitus. 
Research Design and Methods: In November–December 2005, a mailed survey went to a random, cross-sectional sample of 683 Oregon licensed physicians in obstetrician/gynecologists and family medicine from a population of 2171.
Results: Routine postpartum glucose tolerance testing by both family physicians (19.3%) and obstetrician/gynecologists physicians (35.3%) was reportedly low among the 285 respondents (42% response rate). Factors associated with high
adherence to postpartum testing included physician stated priority (OR 4.39, 95% CI: 1.69–7.94) and physician beliefs about norms or typical testing practices (OR 3.66, 95% CI: 1.65–11.69). Specialty, sex of physician, years of practice, location, type of practice, other attitudes and beliefs were not associated with postpartum glucose tolerance testing.
Conclusions: Postpartum glucose tolerance testing following a gestational diabetes mellitus pregnancy was not routinely practiced by responders to this survey. Our findings indicate that physician knowledge, attitudes and beliefs may in part explain suboptimal postpartum testing. Although guidelines for postpartum care are established, some physicians do not prioritize these guidelines in practice and do not believe postpartum testing is the norm among their peers.

Window of Opportunity: Postpartum Screening of Women with Gestational Diabetes for Early Detection of Prediabetes and Type 2 Diabetes Cassandra E. Henderson, Jan Kavookjian, Harris Leitstein, June M. McKoy, Wambui Jane Murage, and Ruth D. Lipman. The Open Diabetes Journal, 2012, 5, 25-28

Abstract: Gestational diabetes is a condition characterized by glucose intolerance during pregnancy, with defined approaches for screening, treatment, and follow-up. It is associated with a variety of adverse birth outcomes, including excessive fetal weight gain and related increases in the rate of cesarean delivery and perinatal injury as well as increased risk for developing type 2 diabetes for women who have had gestational diabetes. A diagnosis of gestational diabetes may also be a manifestation of pre-existing type 2 diabetes. Nonetheless, a substantial proportion of women with a history of gestational diabetes fail to receive the recommended postpartum glucose screening. This failure to conduct follow-up screening of women with gestational diabetes after delivery represents a missed opportunity for earlier diagnosis of diabetes, and chance to increase the awareness of women of their future risk for developing diabetes. This paper explores the barriers contributing to the lack in follow-up screening and makes recommendations about addressing these problems. 
Archived articles (prior to 2009)

Gestational Diabetes Mellitus Diagnosed with a 2 hour, 75 g, Oral Glucose Tolerance Test and Adverse Pregnancy Outcomes Maria I. Schmidt, MD, PhD; Bruce B. Duncan, MD, PhD; Angela J. Reichelt, MD, PhD; Leandro Branchtein, MD, PhD; Maria C. Matos, MD, PhD; Adriana Costa E Forti, MD, PhD; Ethel R. Spichler, MD, PhD; Judith, M. D. C. Pousada, MD, PhD; Margareth M. Teixeira, MD, MS; Tsuyoshi Yamashita, MD for the Brazilian Gestational Diabetes Study Group. Diabetes Care, Volume 24, Number 7, July 2001

OBJECTIVE— To evaluate American Diabetes Association (ADA) and World Health Organization (WHO) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes.
RESEARCH DESIGN AND METHODS— This cohort study consecutively enrolled Brazilian adult women attending general prenatal clinics. All women were requested to undertake a standardized 2-h 75-g oral glucose tolerance test (OGTT) between their estimated 24th and 28th gestational weeks and were then followed to delivery. New ADA criteria for GDM require two plasma glucose values ? 5.3 mmol/l (fasting), ?10 mmol/l (1 h), and ?8.6 mmol/l (2 h). WHO criteria require a plasma glucose ?7.0 mmol/l (fasting) or ?7.8 mmol/l (2 h). Individuals with hyperglycemia indicative of diabetes outside of pregnancy were excluded.
RESULTS— Among the 4,977 women studied, 2.4% (95% CI 2.0 –2.9) presented with GDM by ADA criteria and 7.2% (6.5–7.9) by WHO criteria. After adjustment for the effects of age, obesity, and other risk factors, GDM by ADA criteria predicted an increased risk of macrosomia (RR 1.29, 95% CI 0.73–2.18), preeclampsia (2.28, 1.22– 4.16), and perinatal death (3.10, 1.42– 6.47). Similarly, GDM by WHO criteria predicted increased risk for macrosomia (1.45, 1.06 –1.95), preeclampsia (1.94, 1.22–3.03), and perinatal death (1.59, 0.86 –2.90). Of women positive by WHO criteria, 260 (73%) were negative by ADA criteria. Conversely, 22 (18%) women positive by ADA criteria were negative by WHO criteria.
CONCLUSIONS— GDM based on a 2-h 75-g OGTT defined by either WHO or ADA criteria predicts adverse pregnancy outcomes.

Preventing Type 2 DM: Public Health Implications For Women With a History of Gestational Diabetes Mellitus Lucinda J. England, MD, MSPH; Patricia M. Dietz, DrPH, MPH; Terry Njoroge, MPH; William M. Callaghan, MD, MPH; Carol Bruce, BSN, MPH; Rebecca M. Buus, PhD; David F. Williamson, PhD. American Journal of Obstetrics & Gynecology 2008 

There is now strong evidence that lifestyle modification can prevent or delay the development of type 2 diabetes mellitus in high-risk individuals. Women with gestational diabetes mellitus are at increased risk for type 2 diabetes and so are candidates for prevention programs. We review literature on type 2 diabetes risk in women with gestational diabetes, examine current recommendations for postpartum and long-term follow-up, and summarize findings from a 2007 expert-panel meeting. We found data to support that women with gestational diabetes have an increase in risk of type 2 diabetes comparable in magnitude with that of individuals with impaired glucose tolerance and/or impaired fasting glucose and that prevention interventions likely are effective in this population. Current recommendations from leading organizations on follow-up of women after delivery are conflicting and compliance is poor. Clinicians and public health workers face numerous challenges in developing intervention strategies for this population. Translation research will be critical in addressing this important public health issue.

Risk Perception for Diabetes Among Women With Histories of Gestational Diabetes Mellitus Catherine Kim, MD, MPH; Laura N. McEwen, PhD; John D. Piette, PhD; Jennifer Goewey, MHA; Assiamira Ferrara, MD, PhD; Elizabeth A. Walker PhD, RN  Diabetes Care, Volume 30, Number 9, September 2007

OBJECTIVE — To examine risk perception for diabetes among women with histories of gestational diabetes mellitus (GDM).
RESULTS — Ninety percent of women recognized that GDM was a risk factor for future diabetes, but only 16% believed that they themselves had a high chance of developing diabetes; perceived risk increased to 39% when women were asked to estimate their risk assuming they maintained their current lifestyle. Women who consumed three or more but less than five servings a day of fruits and vegetables reported lower odds of moderate/high risk perception (adjusted odds ratio [OR] 0.39 [95% CI 0.16 – 0.92]) than women who consumed less than three servings a day, although this association was not significant after further adjustment for income. Women who perceived themselves to be at moderate/high risk more often planned to modify their future lifestyle behaviors (9.1 [0.16 – 0.92]).
CONCLUSIONS — Despite understanding the association between GDM and postpartum diabetes, women with histories of GDM usually do not perceive themselves to be at elevated risk.

Modifiable Risk Factors for Developing Diabetes Among Women With Previous GDM Shumei Yun, MD, PhD, Nisreen H. Kabeer, MPH, Bao-Ping Zhu, MD, MS, Ross C. Brownson, PhD.  Prev Chronic Dis 2007 Jan. 

Introduction-Gestational diabetes mellitus (GDM) affects approximately 2% to 4% of all pregnant women in the United States each year. Women who have had GDM are at high risk for developing nongestational diabetes. The objective of this study was to assess the prevalence of modifiable risk factors for developing diabetes among women with previous GDM only.
Methods-Cross-sectional data for nonpregnant women from the 2003 Behavioral Risk Factor Surveillance System were used to estimate and compare the prevalence of modifiable risk factors among three groups: nonpregnant women with previous GDM only, nonpregnant women with current diabetes, and nonpregnant women without diabetes.
Results-In 2003, 7.6% of nonpregnant women aged 18 years and older in the United States had current self-reported physician-diagnosed diabetes, and 1.5% had previous GDM only. Compared with women without diabetes, women with previous GDM only had higher prevalence of no leisure-time physical activity (32.0% vs 25.7%), overweight (62.2% vs 49.0%), and obesity (29.4% vs 20.0%).
After adjusting for sociodemographic variables, women with previous GDM only were more likely to have no leisure-time physical activity (prevalence odds ratio [POR], 1.4; 95% confidence interval [CI], 1.2–1.7) and more likely to be overweight (POR, 1.8; 95% CI, 1.6–2.2) or obese (POR, 1.7; 95% CI, 1.4–2.1), compared with women with no diabetes.
Conclusion-Women with previous GDM are more likely to have modifiable risk factors for developing diabetes than women without diabetes. More attention to this issue is needed from health care providers and public health officials to encourage the promotion of healthy lifestyles during and after pregnancy.

Prevention, Screening and Diagnosis Articles

Preventable health and cost burden of adverse birth outcomes associated with pregestational diabetes in the United States Cora Peterson, PhD; Scott D. Grosse, PhD; Rui Li, PhD; Andrea J. Sharma, PhD; Hilda Razzaghi, PhD; William H. Herman, MD, MPH; Suzanne M. Gilboa, PhD.  Am J Obstet Gynecol 2015;212:74.e1-9.

OBJECTIVE: Preconception care for women with diabetes can reduce the occurrence of adverse birth outcomes. We aimed to estimate the preconception care (PCC) – preventable health and cost burden of adverse birth outcomes associated with diagnosed and undiagnosed pregestational diabetes mellitus (PGDM) in the United States.
STUDY DESIGN: Among women of reproductive age (15-44 years), we estimated age- and race/ethnicity-specific prevalence of diagnosed and undiagnosed diabetes. We applied age and race/ethnicity-specific pregnancy rates, estimates of the risk reduction from PCC for 3 adverse birth outcomes (preterm birth, major birth defects, and perinatal mortality), and lifetime medical and lost productivity costs for children with those outcomes. Using a probabilistic model, we estimated the reduction in adverse birth outcomes and costs associated with universal PCC compared with no PCC among women with PGDM. We did not assess maternal outcomes and associated costs.
RESULTS: We estimated 2.2% of US births are to women with PGDM. Among women with diagnosed diabetes, universal PCC might avert 8397 (90% prediction interval [PI], 5252-11,449) preterm deliveries, 3725 (90% PI, 3259-4126) birth defects, and 1872 (90% PI, 1239-2415) perinatal deaths annually. Associated discounted lifetime costs averted for the affected cohort of children could be as high as $4.3 billion (90% PI, 3.4-5.1 billion) (2012 US dollars). PCC among women with undiagnosed diabetes could yield an additional $1.2 billion (90% PI, 951 million-1.4 billion) in averted cost.
CONCLUSION: Results suggest a substantial health and cost burden associated with PGDM that could be prevented by universal PCC, which might offset the cost of providing such care.

An Early Pregnancy HbA1c $5.9% (41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes Ruth C.E. Hughes, M. Peter Moore, Joanna E. Gullam, Khadeeja Mohamed, Janet Rowan. Diabetes Care Published Ahead of Print, published online September 4, 2014 

OBJECTIVE- Pregnant women with undiagnosed diabetes are a high-risk group that may benefit from early intervention. Extrapolating from nonpregnancy data, HbA1c ‡6.5% (48 mmol/mol) is recommended to define diabetes in pregnancy. Our aims were to determine the optimal HbA1c threshold for detecting diabetes in early pregnancy as defined by an early oral glucose tolerance test (OGTT) at <20 weeks’ gestation and to examine pregnancy outcomes relating to this threshold.
RESEARCH DESIGN AND METHODS-During 2008–2010 in Christchurch, New Zealand, women were offered an HbA1c measurement with their first antenatal bloods. Pregnancy outcome data were collected. A subset completed an early OGTT, and HbA1c performance was assessed using World Health Organization criteria.
RESULTS-HbA1c was measured at a median 47 days’ gestation in 16,122 women. Of those invited, 974/4,201 (23%) undertook an early OGTT. In this subset, HbA1c ‡5.9% (41 mmol/mol) captured all 15 cases of diabetes, 7with HbA1c <6.5% (<48mmol/mol). This HbA1c threshold was also 98.4% (95% CI 97–99.9%) specific for gestational diabetes mellitus (GDM) before 20 weeks (positive predictive value = 52.9%). In the total cohort, excluding women referred for GDM management, women with HbA1c of 5.9–6.4% (41–46 mmol/mol; n = 200) had poorer pregnancy outcomes than those with HbA1c <5.9% (<41 mmol/mol; n = 8,174): relative risk (95% CI) of major congenital anomaly was 2.67 (1.28–5.53), preeclampsia was 2.42 (1.34–4.38), shoulder dystocia was 2.47 (1.05–5.85), and perinatal death was 3.96 (1.54–10.16). 
CONCLUSIONS-HbA1c measurements were readily performed in contrast to the low uptake of early OGTTs. HbA1c ‡5.9% (‡41 mmol/mol) identified all women with diabetes and a group at significantly increased risk of adverse pregnancy outcomes.

Lack of Peri-conceptional Vitamins or Supplements Containing Folic Acid and Diabetes-associated Birth Defects Accepted manuscript: Correa, A., Gilboa, S.M., Botto, L.D., Moore, C.A., Hobbs, C.A., Cleves, M.A., Riehle-Colarusso, T.J., Waller, D.K., Reece, E.A., National Birth Defects Prevention Study. American Journal of Obstetrics and Gynecology 2011). 

OBJECTIVE: To examine the risk of birth defects in relation to lack of use of Peri-conceptional vitamins or supplements containing folic acid and diabetes.
STUDY DESIGN: The National Birth Defects Prevention Study (1997–2004), a multicenter, population-based case-control study of birth defects (14,721 case and 5,437 control infants). Cases were categorized into 18 types of heart defects and 26 non-cardiac birth defects. We estimated odds ratios for independent and joint effects of pre-existing diabetes and lack of Peri-conceptional use of vitamins or supplements containing folic acid.
RESULTS: The pattern of odds ratios suggested an increased risk of defects associated with diabetes in the absence versus the presence of Peri-conceptional use of vitamins or supplements containing folic acid.
CONCLUSIONS: Lack of Peri-conceptional use of vitamins or supplements containing folic acid may be associated with an excess risk for birth defects due to diabetes.

Preventing Type 2 DM: Public Health Implications For Women With a History of Gestational Diabetes Mellitus Lucinda J. England, MD, MSPH; Patricia M. Dietz, DrPH, MPH; Terry Njoroge, MPH; William M. Callaghan, MD, MPH; Carol Bruce, BSN, MPH; Rebecca M. Buus, PhD; David F. Williamson, PhD. American Journal of Obstetrics & Gynecology, 2008.

There is now strong evidence that lifestyle modification can prevent or delay the development of type 2 diabetes mellitus in high-risk individuals. Women with gestational diabetes mellitus are at increased risk for type 2 diabetes and so are candidates for prevention programs. We review literature on type 2 diabetes risk in women with gestational diabetes, examine current recommendations for postpartum and long-term follow-up, and summarize findings from a 2007 expert-panel meeting. We found data to support that women with gestational diabetes have an increase in risk of type 2 diabetes comparable in magnitude with that of individuals with impaired glucose tolerance and/or impaired fasting glucose and that prevention interventions likely are effective in this population. Current recommendations from leading organizations on follow-up of women after delivery are conflicting and compliance is poor. Clinicians and public health workers face numerous challenges in developing intervention strategies for this population. Translation research will be critical in addressing this important public health issue. 

New Study on Healthy Maternal Diet and Reduced Risks of Birth Defects October 3, 2011 online publication of the Archives of Pediatrics and Adolescent Medicine. The WIC Wire, May 2012, Volume 6, Issue 5, Utah Department of Health WIC Program.

This new study from the Stanford University School of Medicine has shown that women who ate better before and during their pregnancy gave birth to fewer infants who had anomalies of the brain and spinal cord, or orofacial clefts, such as cleft lip and cleft palate. Previous research has focused on one nutrient at a time. For example folic acid has been shown to protect against brain or spinal cord anomalies (examples are anencephaly and spina bifida). However, after fortification of the U.S. food supply with folic acid, these types of birth defects did not disappear completely. Thus, other single nutrient studies were conducted to assess possible diet – defect associations or connections.

Preventive Services for Women: New and Important Changes in Covered Services Rebekah E. Gee, MD, MPH.

Under the Patient Protection and Affordable Care Act of 2010 (ACA), coverage for a variety of important preventive health care services is required by new (non-grandfathered) health plans with no cost sharing as of September 23, 2010, when services are rendered by an in-network provider. However, although women’s healthcare needs are widely recognized as different from those of men, no single body of recommendations specific to women’s preventive services existed at the time the ACA was signed into law. As such, the law required coverage of: “with respect to women, evidence-informed preventive care and screening provided for in comprehensive guidelines supported by [The Health Resources and Services Administration] (not otherwise addressed by the recommendations of the [U.S. Preventive Services] Task Force).”

A simple scoring method using cardiometabolic risk measurements in pregnancy to determine 10-year risk of type 2 diabetes in women with gestational diabetes. A. Barden, R. Singh, B. Walters, M. Phillips, and LJ Beili.  Nutrition & Diabetes (2013) 3, e72.   

OBJECTIVE: To examine if clustering of cardiometabolic risk factors in pregnancy predicts type 2 diabetes and cardiovascular disease (CVD) risk at 10 years in women with gestational diabetes