Interventions to Increase Access to Care and Quality of Care for Women With Gestational Diabetes.

The prevalence of gestational diabetes mellitus (GDM) in the United States is increasing, and rates in some populations range from 3 to 14%.1–3 The true prevalence of GDM may be even higher because underreporting of GDM on birth certificates is well documented.1–4 Difficulties in documenting and reaching consensus on the prevalence of GDM exist for a number of reasons, including the use of various diagnostic criteria, past confusion about the specific criteria used to diagnose GDM, and the lack of a universal recommendation for screening and diagnosis.5,6 In previous publ icat ions, 5 –7 researchers have outlined and critiqued the various GDM guidelines established by professional organizations. Most agree on assessment of the risk for GDM for all pregnant women, with the exception of the U.S. Preventive Service Task Force.8 However, they differ on testing procedures, diagnostic criteria, target blood glucose levels during pregnancy, and scheduled postpartum testing and follow-up for diabetes.5,6 A lack of consensus regarding screening for and diagnosing GDM is concerning because it can be a barrier for health care providers (HCPs) in diagnosing and documenting GDM in medical records and on birth certificates. Appropriate documentation of GDM in hospital and prenatal care records and on birth certificates would increase identification of women at risk for type 2 diabetes and facilitate outreach by HCPs to ensure that they receive the information and resources needed to help prevent the development of diabetes in the future.9 This article describes intervention efforts and the results of a pilot project called The GDM Collaborative: Better Data, Better Care that are being funded by the Centers for Disease Control and Prevention in collaboration with the National Association of Chronic Disease Directors and the National Association of Maternal and Child Health Programs. The GDM Collaborative was developed to establish a multistate program to: • Identify, catalog, and validate routinely collected GDM prevalence data; • Identify gaps in the quality of GDM prevalence data and documented care; • Develop interventions to improve access to care and increase postpartum follow-up for women with a history of GDM; and • Enhance collaborations among public health programs.