JMIR Publications

ABSTRACT

Background:

Background:

Universal hemoglobin A1c (HbA1c) screening in pregnancy leads to increased identification of impaired glucose tolerance (IGT). If patients with IGT never develop gestational diabetes, they may not receive nutritional support, counseling regarding long-term metabolic risks after pregnancy, or formal transition of care to primary care providers (PCPs).

Objective:

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 at the start of 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 wraparound postpartum visit focused on IGT, July 2022-April 2023).

Methods:

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 comparative analysis between the BRIDGE cohort and 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+.

Results:

Results:

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:

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-focused counseling, highlighting key areas for improvement in the quality of postpartum transitions to primary care.