Data to Action Success Story: Utah

Using Utah PRAMS Data to Assess Gestational Diabetes Mellitus Reporting and to Evaluate Public Education Efforts

During the past decade, the prevalence of gestational diabetes mellitus (GDM) among Utah women has increased by 48%. Women diagnosed with GDM have a 20%–50% lifetime risk of developing type 2 diabetes. Accurate reporting and follow-up of women with GDM has been difficult. The American College of Obstetricians and Gynecologists (ACOG) recommends that all women with gestational diabetes be tested for diabetes at the 6-week postpartum visit and at regular intervals thereafter. Insufficient data on the prevalence of diabetes make it difficult to target appropriate women for education and intervention. Comparing diabetes data taken from birth certificates with self-reported data from the PRAMS survey shows a wide variation in prevalence of diabetes. Utah mothers self-report nearly double the rate of diabetes than what is recorded on the birth certificate.

Program Activity Description

In the initial phase of the project, Utah PRAMS used data from 2004 to identify which hospital charts were to be reviewed. The Maternal and Infant Health program initially reviewed reporting of GDM on birth certificates and found, when compared with self-reported data on GDM diagnosis using PRAMS, several diagnosed cases were missing from the birth certificate. In addition, the review also revealed that the PRAMS question wording was confusing to women, prompting the question to be modified in 2009 with the phase VI PRAMS survey revision. Utah added the revised PRAMS question to the Vital Records hospital maternal worksheet that mothers complete, and a second chart review process was initiated.

Program Activity Outcomes

As a result of the discrepancies found during the chart review process, annual training of medical records personnel to improve reporting of GDM in Utah was initiated. To capture better data, the Utah Office of Vital Records and Statistics modified the data entry program for birth certificates to collect maternal self-report of gestational diabetes and added an edit to the system that will flag the clerk if the gestational diabetes fields are in conflict. At the same time the chart reviews were conducted, the Maternal and Infant Health Program and the Diabetes Prevention and Control Program teamed up to develop patient education materials for women with GDM. Each week, Vital Records staff generates a list of women whose birth certificates indicated they had GDM. Those women are mailed a packet of educational materials, which includes a letter explaining the packet, tips for reducing their risks of developing type 2 diabetes, and a card stressing the importance of having their blood sugars tested at a 6-week postpartum visit.