Evidence map›Paper›PMID 30097012›Full record

ArticleBMC health services research2018

Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation.

Julius Ho, Karen Bachman-Carter, Shelley Thorkelson, Kristi Anderson, Jennifer Jaggi, Chris Brown, Adrianne Katrina Nelson, Cameron Curley, Caroline King, Sid Atwood and 1 more

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Article in BMC health services research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors.

Julius HoDepartment of Medicine, Johns Hopkins School of Medicine, 1800 Orleans St, Baltimore, MD, 21298, USA.
Karen Bachman-CarterNorthern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA.
Shelley ThorkelsonNorthern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA.
Kristi AndersonNorthern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA.
Jennifer JaggiGallup Indian Medical Center, Indian Health Service, Gallup, NM, USA.
Chris BrownDivision of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.
Adrianne Katrina NelsonDepartment of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA, 02115, USA.
Cameron CurleyDivision of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.
Caroline KingDivision of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.
Sid AtwoodDivision of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA.
Sonya ShinDivision of Global Health Equity, Brigham and Women's Hospital, 210 East Aztec Avenue, Gallup, NM, 87301, USA. sshin@partners.org.ORCID http://orcid.org/0000-0003-3466-9055

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNative American communities experience greater burden of diabetes than the general population, including high rates of Type 2 diabetes among women of childbearing age. Diabetes in pregnancy is associated with risks to both the mother and offspring, and glycemic control surrounding the pregnancy period is of vital importance.

methodsA retrospective chart review was conducted at a major Navajo Area Indian Health Service (IHS) hospital, tracking women with pre-existing diabetes who became pregnant between 2010 and 2012. Logistic regression was performed to find patient-level predictors of our desired primary outcome-having hemoglobin A1c (HbA1c) consistently < 8% within 2 years after pregnancy. Descriptive statistics were generated for other outcomes, including glycemic control and seeking timely IHS care.

resultsOne hundred twenty-two pregnancies and 114 individuals were identified in the dataset. Baseline HbA1c was the only covariate which predicted our primary outcome (OR = 1.821, 95% CI = 1.184-2.801). Examining glycemic control among pregnancies with complete HbA1c data (n = 59), 59% were controlled before, 85% during, and 34% after pregnancy. While nearly all women received care in the immediate postpartum period, only 49% of women visited a primary care provider and 71% had HbA1c testing in the 2 years after pregnancy.

conclusionsThis is the first analysis of outcomes among women with diabetes in pregnancy in Navajo Nation, the largest reservation and tribal health system in the United States. Our findings demonstrate the positive impact of specialized prenatal care in achieving glycemic control during pregnancy, while highlighting the challenges in maintaining glycemic control and continuity of healthcare after pregnancy.

Indexed as

AdolescentAdultArizonaBlood GlucoseDiabetes Mellitus, Type 2Facilities and Services UtilizationFemaleGlycated HemoglobinHealth Services, IndigenousHumansIndians, North AmericanLogistic ModelsMiddle AgedNew MexicoPatient Acceptance of Health CarePostnatal CareBlood GlucoseGlycated HemoglobinDiabetesGlycemic controlHealthcareNative AmericanPost-partumPregnancy

Identifiers

PMID30097012
PMCPMC6086058

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.