Postpartum diabetes monitoring remains low among many new mothers

Few women with postpartum-onset diabetes meet recommended A1C monitoring guidelines, highlighting a need to improve routine diabetes care-particularly among Black women-according to new research at Columbia University Mailman School of Public Health. The study is published in BMJ.

Limited evidence suggests that social determinants of health (SDOH) influence diabetes incidence and control, but far less is known about their role in adherence to monitoring guidelines. Prior studies have documented disparities in diabetes care and gaps in screening among premenopausal women, yet no research to date has examined how SDOH shapes access to A1C testing in the postpartum period-a time when women may face distinct social and structural barriers to care.

Our study provides first-of-its-kind evidence on the relationship between social determinants of health and recommended A1C monitoring among postpartum women with newly diagnosed diabetes. Our findings reveal disparities by race and ethnicity, insurance, and parity-and show that most women are not meeting recommended testing intervals."

Natalie Boychuk, doctoral student in Epidemiology at Columbia Mailman School

Diabetes is increasingly prevalent among reproductive-aged women, yet access to recommended follow-up care after diagnosis remains poorly understood. Monitoring glycemic control is a cornerstone of diabetes management and a strong predictor of complications. Hemoglobin A1C (A1C) reflects average blood glucose over three months, and the American Diabetes Association recommends testing at least twice per year for patients with stable type 2 diabetes.

To address this gap, researchers analyzed data from a retrospective, population-based cohort of 5,590 women in New York City who delivered babies between 2009 and 2016 and developed postpartum-onset diabetes. Using linked birth certificate, hospital discharge, and A1C registry data, the study evaluated associations between SDOH-including race and ethnicity, delivery, insurance status, education, nutrition program enrollment, and parity -and both timing to first A1C test and overall testing rates. Analyses adjusted for such characteristics as body mass index, gestational diabetes, and age.

Overall, adherence to recommended monitoring was low: only 13 percent of women received all guideline-recommended biannual A1C tests during follow-up. Significant disparities emerged. Non-Hispanic Black women were less likely to receive timely follow-up testing and had lower overall testing rates compared with non-Hispanic White women. Women with more children also experienced longer delays and lower testing frequency. In contrast, women insured by Medicaid at delivery were more likely to receive earlier follow-up testing and had higher overall testing rates than those with private or other insurance.

"Our findings are consistent with prior research showing that Black adults with diabetes are less likely than White adults to receive recommended A1C monitoring. Although the study did not observe differences in testing rates between Hispanic and White women, aligning with earlier evidence, there is a body of evidence that suggests that Hispanic people experience disparities in outcomes, and additional research is needed to understand that paradox," noted Boychuk.

The relative advantage observed among women insured by Medicaid is notable and warrants further investigation into how coverage and related supports may improve engagement in care. More broadly, the results underscore the need for targeted strategies to improve postpartum diabetes management, including interventions that address social and structural barriers.

"This study highlights an important opportunity to better engage reproductive-aged women in routine diabetes monitoring," said Teresda Janevic, PhD, associate professor of Epidemiology at Columbia Mailman School of Public Health. "Improving access to and uptake of A1C testing in the postpartum period could help improve long-term cardiometabolic health and reduce disparities in diabetes outcomes."

Co-authors are Katharine McCarthy and Shelley Liu, Icahn School of Medicine, Mount Sinai; Frances Howell, Bohao Wu, and Sandra Albrecht, Columbia Mailman School; and Hiu Tai Chan, Joseph Kennedy and Kacie Sell, NYC Department of Health and Mental Hygiene.