Rural and urban disparities in postpartum glucose screening rates

Although the overall rate of adherence to postpartum glucose screening is low (less than 50%), the geographical disparities, rural versus urban, in postpartum glucose screening rates for women with gestational diabetes are relatively unknown.

The purpose of this study was to compare postpartum glucose screening rates between women living in rural versus urban areas. Secondarily, this study evaluated the impact of transfer of maternity care on adherence to postpartum care and glucose screening rates in women with gestational diabetes mellitus.

Through retrospective chart review, data were collected from records with a diagnosis of gestational diabetes between January 2015 and October 2020.

Subjects were classified as urban or rural residents. The following data were collected: number of prenatal and postpartum care visits, number of prenatal and postpartum glucose testing, infant birthweight, maternal complications, and demographic data, including race, age, and insurance status.

Our final sample consisted of 82 women classified as urban and 67 classified as rural. Overall, the number of postpartum glucose tests was lower in the rural group (M = 0.30), compared to the urban group (M = 0.52) and demonstrated statistically significant differences with Poisson regression (coefficient 0.56, Wald chi-square = 4.59, p = 0.03). Women from rural areas, who were referred and transferred maternity care to the Regional Perinatal Health Care Center, had the lowest average postpartum visits (M = 1.00) and postpartum glucose tests (M = 0.22) compared to the women from urban areas who were transferred from other providers with mean postpartum visits (M = 1.46) and mean postpartum glucose tests (M = 0.29).

Rural women received lower postpartum glucose screening than those residing in urban areas. This finding illustrates greater disparities among rural women seeking postpartum care. Larger prospective studies are warranted to examine contributing factors, such as continuity of care and the transition from postpartum care to primary care. The remaining significant need is for healthcare providers to facilitate preventive care following pregnancy, including timely glucose screening and detection of women at high risk for developing type 2 diabetes, especially among rural populations.