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. 2023 May-Jun;33(3):273-279.
doi: 10.1016/j.whi.2022.12.004. Epub 2023 Jan 19.

Social Vulnerability and Initiation of Pharmacotherapy for Gestational Diabetes Mellitus in a Medicaid Population

Amelie Pham  1 , Andrew D Wiese  2 , Andrew J Spieker  3 , Sharon E Phillips  3 , Margaret A Adgent  2 , Carlos G Grijalva  4 , Sarah S Osmundson  5
Affiliations

Social Vulnerability and Initiation of Pharmacotherapy for Gestational Diabetes Mellitus in a Medicaid Population

Amelie Pham et al. Womens Health Issues. 2023 May-Jun.

Abstract

Objective: Our study examines the association between social vulnerability index (SVI) and pharmacotherapy initiation for gestational diabetes mellitus (GDM).

Methods: We studied a retrospective cohort of pregnant patients with GDM, enrolled in Tennessee Medicaid, who gave birth between 2007 and 2019. Enrollment files were linked to birth and death certificates, state hospitalization registries, and pharmacy claims. SVI, measured at the community level and determined by residential census tract, ranged from 0 to 100 (low to high vulnerability). Multivariable logistic regression assessed the association between SVI and the odds of initiating the most common pharmacotherapies for GDM-insulin, glyburide, or metformin-and adjusted for relevant covariates. SVI was modeled with restricted cubic splines to account for nonlinear associations, using the median Tennessee SVI as a reference. Secondary analysis assessed associations with the SVI subthemes.

Results: Among 33,291 patients with GDM, 21.7% (7,209) initiated pharmacotherapy during pregnancy. Patients from areas with higher SVI were more likely to be non-Hispanic Black with higher body mass index, whereas those with lower SVI were more likely to be nulliparous. Multivariable modeling demonstrated a complex nonlinear association between SVI and GDM pharmacotherapy initiation, relative to the reference. Higher SVI was associated with elevated odds of GDM pharmacotherapy initiation (e.g., odds ratio 1.11 [95% confidence interval 1.02-1.22] for SVI 80) and low to medium SVI had variable nonsignificant associations with GDM pharmacotherapy initiation, relative to the reference (lower odds of initiation for values 25-50, higher odds of initiation for values < 25). Secondary analysis demonstrated a nonlinear association between subtheme 3 and the odds of GDM pharmacotherapy initiation.

Conclusion: Social vulnerability is associated with initiation of pharmacotherapy for GDM, highlighting the possible role of social determinants of health in achieving glycemic control.

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Conflict of interest statement

C.G.G. reports consulting fees from Pfizer, Sanofi, and Merck, and received research support from Sanofi-Pasteur, the Campbell Alliance/Syneos Health, NIH, CDC, FDA and AHRQ. A.D.W. reports consulting fees from the Tennessee Department of Health. All other authors report no conflict of interest.

Figures

FIGURE 1.
FIGURE 1.. Flow Diagram
Flow diagram for our study population and complete case analysis.
FIGURE 2.
FIGURE 2.. Adjusted Odds Ratios of Initiating Pharmacotherapy for GDM Management
Blue: adjusted odds ratio; Red: reference line; Gray bars: 95th % confidence interval Figure 2 represents the adjusted odds ratios for initiation of pharmacotherapy for GDM management by SVI from a logistic regression model using restricted cubic spline terms for SVI. Covariates identified a priori that were adjusted for in the model included maternal age, pre-pregnancy BMI, parity, birth year, and gestational age at diagnosis of GDM.
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References

    1. ACOG. (2018). Gestational Diabetes Mellitus ACOG Practice Bulletin. ACOG practice bulletin, Number 190. Retrieved from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articl... Accessed March 1, 2022
    1. Arora KS, Ascha M, Wilkinson B, Verbus E, Montague M, Morris J, & Einstadter D (2020). Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization. BMC Public Health, 20(1), 1440. 10.1186/s12889-020-09540-5 - DOI - PMC - PubMed
    1. Bardenheier BH, Imperatore G, Gilboa SM, Geiss LS, Saydah SH, Devlin HM, Kim SY, & Gregg EW (2015). Trends in Gestational Diabetes Among Hospital Deliveries in 19 U.S. States, 2000–2010. Am J Prev Med, 49(1), 12–19. 10.1016/j.amepre.2015.01.026 - DOI - PMC - PubMed
    1. Biggs EN, Maloney PM, Rung AL, Peters ES, & Robinson WT (2020). The Relationship Between Social Vulnerability and COVID-19 Incidence Among Louisiana Census Tracts. Front Public Health, 8, 617976. 10.3389/fpubh.2020.617976 - DOI - PMC - PubMed
    1. Camelo Castillo W, Boggess K, Sturmer T, Brookhart MA, Benjamin DK Jr., & Jonsson Funk M (2014). Trends in glyburide compared with insulin use for gestational diabetes treatment in the United States, 2000–2011. Obstet Gynecol, 123(6), 1177–1184. 10.1097/AOG.0000000000000285 - DOI - PMC - PubMed

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