Delayed Access to Insulin During Pregnancy

To evaluate the frequency of delay in insulin access following prescription of a new insulin regimen among pregnant patients with gestational diabetes mellitus or preexisting type 2 diabetes mellitus and to examine associated factors.

We conducted a retrospective review of electronic health records of pregnant patients with gestational diabetes mellitus or preexisting type 2 diabetes mellitus seen at the Mass General Brigham between June 2018 and June 2024. Patients newly prescribed insulin during pregnancy were sampled (n = 303) for detailed chart review. Delay in insulin access (≥7 days between prescription and the day medication was dispensed) was defined using electronic prescription and fill history. Social determinants of health were assessed via the Center for Disease Control Social Vulnerability Index (SVI). Multivariable logistic regression was used to assess associations between delay and demographic/clinical factors.

Among 303 pregnant patients newly prescribed insulin, 15.5% experienced delayed insulin access. The delayed group had higher proportions of self-identified Black race (33.3% vs 8.2%, P < .001), single marital status (38.3% vs 20.6%, P = .009), interpreter requirement (14.9% vs 5.5%, P = .019), and residence in high-SVI areas (51% vs 30.5%, P = .01). Common barriers were insurance-related (46.8%) and patient preference (27.6%). In multivariable analysis, Black race (odds ratio [OR] = 6.01, 95% CI 2.45-14.76, P < .001) and prescription year 2022-2024 vs 2018-2021 (OR = 2.35, 95% CI 1.10-5.01, P = .02), remained significant. High SVI (OR = 2.07, 95% CI 0.996-4.304, P = .05) showed borderline significance.

Delays in insulin access during pregnancy are common and disproportionately affect Black women, with insurance-related barriers predominant. Strategies to reduce delays may improve maternal and fetal outcomes in pregnancies complicated by diabetes.