1433-P: Does Physician Counseling Regarding Lifestyle Choices Impact Postpartum Visit Attendance among Pregnant Women with Diabetes?

Objective: To determine whether physician lifestyle counseling during prenatal care for patients with diabetes is associated with increased attendance at postpartum visit.

Study Design: We performed a retrospective cohort study of pregnant women with type 1, type 2 and gestational diabetes who received prenatal care at Barnes-Jewish Hospital from June 2009- December 2017. Medical records were reviewed to determine whether the physician documented counseling the patient regarding exercise, diet, weight gain, and whether the patient saw a diabetes educator for at least one visit during the course of prenatal care. Logistic regression was used to identify the association between physician counseling and 6-week postpartum visit attendance after controlling for age, race, employment, education, number of prenatal visits, delivery complications, and delivery mode.

Results: Of 638 patients in the cohort, 319 (50%) were documented to have received lifestyle counseling from their physician: 82 (26%) on exercise, 277 (87%) on diet, and 100 (31%) on recommended gestational weight gain. Most patients (87%) saw a diabetes educator. Demographic characteristics were similar between women who received lifestyle counseling and those who did not. Seventy-three percent of patients attended the 6-week postpartum visit and women with documentation of lifestyle counseling were nearly twice as likely to attend as those without (aOR 1.87; 95% CI 1.18-2.98). There were no differences in postpartum visit attendance based on consultation with a diabetes educator.

Conclusion: Physician documentation of lifestyle counseling for pregnant women with diabetes is associated with improved rates of postpartum visit attendance, but documentation of counseling remains low. Further study is needed to determine the content/quality of physician lifestyle counseling and its impact on pregnancy and postpartum outcomes among women with pregnancies complicated by diabetes.