LAUSR

Background: Gestational diabetes (GDM) increases risk for type 2 diabetes seven fold. Women with a history of GDM should be screened for diabetes at 4-12 weeks postpartum and every 1-3 years thereafter. We aimed to characterize factors associated with diabetes screening by 12 weeks and 1 year postpartum in a cohort of low-income women with GDM. Methods: A retrospective cohort of 1078 women with GDM who delivered from 2010-2015 was generated by linking electronic health record data from 21 Missouri Federally Qualified Health Centers (FQHCs) with Medicaid administrative claims. Screening rates for diabetes were calculated within 12 weeks and one year of delivery. Two multivariable logistic regression models were constructed to determine associations with recommended screening at these time points. Models were adjusted for age, race/ethnicity, comorbidities, prenatal care, previous birth, and distance from home to health center. Results: Median age was 28 years and 64% of women were racial and ethnic minorities (41% black non-Hispanic). Recommended postpartum screening occurred in 9.7% of women by 12 weeks and 18.9% by 1 year. At 12 weeks and 1 year postpartum, having a prenatal certified diabetes educator visit (12 weeks: aOR 1.9 95% CI 1.1-3.5; 1 year aOR 2.2 95% CI 1.3-3.5) and prior medication for GDM (12 weeks: aOR 2.5 95% CI 1.4-4.3; 1 year aOR 2.7 95% CI 1.7-4.2) were strongly associated with diabetes screening. At 1 year, living in an area with public transportation increased odds of screening two-fold (aOR 2.0 95% CI 1.1-3.8) and each additional encounter with the health system after delivery increased odds of screening by 16% (95% aOR 11-21%). Discussion: Multiple factors are associated with postpartum screening for diabetes in populations with limited resources. Future interventions to increase screening should focus on enhancing access to prenatal certified diabetes education and addressing barriers related to transportation and health system access. Disclosure C.J. Herrick: Stock/Shareholder; Spouse/Partner; Cardinal Health. Y. Yan: None. A. Trolard: None. B.P. Cooper: None. M. Keller: None. M.A. Olsen: Consultant; Self; Pfizer Inc. Research Support; Self; Merck & Co., Inc., Pfizer Inc., Sanofi Pasteur. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1P30DK092950, UL1TR000448, KL2TR000450); National Center for Advancing Translational Science (KL2TR002346, UL1TR002345); Agency for Healthcare Research and Quality (R24HS19455); National Cancer Institute (KM1CA156708)