Continued Disparities in Postpartum Follow-Up and Screening Among Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review.
Emily J Jones, Teri L Hernandez, Joyce K Edmonds and 1 others
PMID 31021939WHAT IT FOUND
Postpartum follow-up and glucose screening after gestational diabetes were often missed, and follow-up after hypertensive disorders was also often missed.
Black, Hispanic, less educated, Medicaid-covered women and women with mental health disorders had lower follow-up. Among attendees, blood pressure screening was nearly universal.
Key findings
01Postpartum follow-up visit rates ranged from 5.7% to 95.4%, and glucose screening rates after gestational diabetes ranged from 5.7% to 57.9%.
02Among women who presented for follow-up after hypertensive disorders of pregnancy or severe preeclampsia, 97.9% and 100% completed blood pressure screening.
03Disparities persisted: Black race, Hispanic ethnicity, less than high school education, Medicaid, mental health disorders, and higher BMI were linked to lower follow-up.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review excluded randomized and experimental studies, so it describes usual care rather than tested interventions. It included nine studies, and only one focused solely on hypertensive disorders of pregnancy, so evidence for blood pressure follow-up is thin. The overall strength of evidence was low to moderate. Most data came from medical records, insurance claims, or a data warehouse, which may miss care that was not documented. One study used self-report, so recall or social desirability bias is possible. Two studies did not evaluate demographic or clinical factors as confounders, so some associations may be biased. Only English-language studies were searched, so relevant studies published in other languages may be missing.
The easy way to misread this
Do not conclude that blood pressure screening is adequate for all women with hypertensive disorders of pregnancy. The high screening rates were reported only among women who attended follow-up visits.