JMIR Publications

ABSTRACT

Background:

Patients with impaired glucose tolerance (IGT) identified in pregnancy who do not develop gestational diabetes often do not receive additional counseling or support regarding their long-term metabolic risks after pregnancy or formal transition of care to primary care providers (PCPs).

Objective:

This pilot study reports the design process and initial program evaluation for the Better followup of ImpaireD GlucosE tolerance (BRIDGE) program, a 12-week text-based postpartum support program promoting lab completion and PCP visit scheduling for patients diagnosed with IGT in early pregnancy. The 19-month program was divided into two arms lasting 9.5 months each, BRIDGE- (text messaging support alone, October 2021-July 2022) and BRIDGE+ (text messaging and IGT-focused postpartum visit, July 2022-April 2023).

Methods:

Patients were eligible for BRIDGE if they received prenatal care at the pilot study site, were diagnosed with IGT in early pregnancy and never developed GDM and could receive English text-messages. We performed a program evaluation using a pre-/post-implementation design comparing outcomes for the BRIDGE cohort to a 19-month historical cohort. Primary outcomes were (1) completion of hemoglobin A1C (HbA1C) by 1 year postpartum and (2) PCP visit scheduling by 12 weeks postpartum. Analysis was stratified by in-network vs out-of-network PCP. We also performed a comparative effectiveness analysis between BRIDGE- and BRIDGE+. Multivariable logistic regressions controlled for history of IGT after stepwise backwards elimination.

Results:

503 individuals were included in the program evaluation (n=342 in historical cohort, n=82 in BRIDGE- and n=79 in BRIDGE+ cohort), with similar demographic and clinical characteristics across cohorts except for history of IGT in prior pregnancy. BRIDGE participants had increased odds of HbA1C completion by 1 year postpartum (39.8% vs 12.5%, aOR 4.28, 95% CI 2.71-6.78) and PCP visit scheduling (31.0% vs 12.0%, aOR 9.58, 95% CI 4.39-20.9) compared to the historical cohort. There were high levels of visit attendance among those who scheduled PCP visits in both the historical and BRIDGE cohorts (92.7 vs 96% of scheduled visits). However, rates of IGT counseling at PCP visits were relatively low in both cohorts (39.5% vs 54.2% of visits). There were no differences in HbA1C completion or PCP visit scheduling between the BRIDGE and BRIDGE+ cohorts.

Conclusions:

Text messaging support with educational and behavioral prompts tripled completion rates of HbA1C screening within 1 year postpartum and doubled the scheduling rate for PCP visits by 12 weeks postpartum. While attendance at scheduled PCP visits was very high, <60% of PCP visits included IGT counseling, highlighting key areas for improvement in the quality of postpartum transitions to primary care. Text messaging support may be an effective tool to incorporate into multi-level approaches to optimizing postpartum transitions of care. Clinical Trial: Not applicable.