The use of an automated call to elicit and characterize postpartum concerns after hospital discharge.

BACKGROUND: The postpartum period is a high-risk time for women, but most women do not have an opportunity to discuss concerns with providers until 4-6 weeks after delivery. OBJECTIVE: The purpose of this study was to evaluate the use of an automated call system to contact postpartum patients within 72 hours of hospital discharge and to identify characteristics that are associated with postpartum concerns. STUDY DESIGN: A prospective cohort of 2948 women in the postpartum period were contacted via an automated call within 72 hours of discharge to elicit concerns. We compared likelihood of successful call and presence of concerns by maternal demographic and medical characteristics using univariate analysis and multivariable logistic regression. RESULTS: Of the participants, 2479 (84.1%) responded to a call after discharge, and 723 (29.1%) reported a concern. Primiparous women were more likely to be contacted successfully than were multiparous women (87.8% vs 79.0%; P<.005) and more likely to have an issue (31.5% vs 25.6%; P=.002). White women were more likely to be contacted successfully than were black, Latina, and Asian or Pacific Islander women (87.1% white, 72.1% black, 80.6% Latina, 85.8% Asian/Pacific Islander; P<.001) but were less likely to report a concern (25.2% white, 33.9% black, 26.5% Latina, 38.3% Asian/Pacific Islander; P<.001). Women with public insurance and those whose neonates were admitted to the intensive care nursery were less likely to be contacted, but these factors were not associated with increased concerns once a successful call was made. When controlling for cofounders, being primiparous and identifying as white were positive predictors of being contacted; having a neonate in the intensive care nursery was a negative predictor. Being primiparous and identifying as non-white were predictors of having a concern. CONCLUSION: Most women responded to a call after hospital discharge, and nearly one-third of them had concerns. The system was not as effective at reaching women with public insurance, women with neonates in the intensive care nursery, and women of color, despite equal or greater numbers of concerns in these groups.

Screening or diagnostic: markedly elevated glucose loading test and perinatal outcomes.

OBJECTIVE: To determine the diagnostic value of markedly elevated 50-g glucose loading test results (>or=200 mg/dL) and associated perinatal outcomes. METHOD: This was a retrospective cohort study of 14 771 pregnancies screened for gestational diabetes mellitus (GDM) between 1988 and 2001. The positive predictive value of the 50-g oral glucose loading test (GLT) results as measured by plasma glucose value was examined. Perinatal outcomes were assessed for women with GLT results >or=200 mg/dL compared to GLT <200 mg/dL, stratified by the diagnosis of GDM. Statistical comparisons were made using the Chi-square test and Student's t-test and potential confounding factors were controlled for using multivariable logistic regression analyses. A p value <0.05 and 95% confidence intervals were used to indicate statistical significance. RESULTS: The positive predictive values for a GDM diagnosis were 62% for GLT results between 180 and 189 mg/dL, 79% for those between 200 and 209 mg/dL, and 100% for GLT results >or=230 mg/dL. Compared to women with a GLT result <200 mg/dL, among women not diagnosed with GDM but with a GLT >or=200 mg/dL the adjusted odds ratio (aOR) for cesarean delivery was 4.18 (95% confidence intervals, 1.15-15.2). These women also had higher aORs for preterm delivery <32 weeks (aOR = 8.05 (1.02-63.6)), shoulder dystocia (aOR = 15.14 (1.64-140)), and their neonates were more likely to have a 5-minute Apgar score <7 (aOR = 6.41 (1.23-33.3)). For women diagnosed with GDM and with a GLT >or=200 mg/dL, the aOR for cesarean delivery was also elevated compared to those with a GLT <200 mg/dL (aOR = 2.24 (1.19-4.21)). CONCLUSION: A GLT value of >or=200 mg/dL is not absolutely diagnostic for gestational diabetes but is associated with unfavorable perinatal outcomes.