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. Author manuscript; available in PMC: 2026 Oct 2.
Published before final editing as: Womens Health Issues. 2026 Sep 4:S1049-3867(26)00076-9. doi: 10.1016/j.whi.2026.05.005

Postpartum Hospital Readmissions among Women with Gestational Diabetes and Pregestational Diabetes in the United States, 2016-2022

Barbara H Bardenheier a, Jean M Lawrence b,c, Ibrahim Zaganjor a, Oscar Rincón-Guevara d, Osatohamwen I Idubor a, Catherine E Barrett e, Dayna S Alexander a, Christopher Holliday a, Holly Du a, Kai McKeever Bullard a
PMCID: PMC13628306  NIHMSID: NIHMS2210246  PMID: 42697809

Abstract

Objective:

We estimated postpartum hospital readmissions trends among women with gestational (GDM), pregestational diabetes (PDM— i.e., diabetes present before pregnancy), and neither.

Methods:

Using the National Readmissions Database, we identified women aged 15-44 who had a live birth or stillbirth between January 1 and June 30 annually, from 2016 through 2022. Births by diabetes status (GDM, PDM, and no diabetes diagnosis) were grouped to obtain: 1) rates of postpartum rehospitalization for all causes, severe maternal morbidity (SMM), diabetes-related diagnoses, and mental health-related diagnoses; 2) repeated admissions; and 3) the leading causes of readmission. Joinpoint regression was used to assess trends in outcomes for 30, 60, and 180 days postpartum.

Results:

During 2016-2022, rates of all-cause postpartum readmissions increased significantly among women with GDM and women without diabetes by 30 days (APC: 2.78 for both), whereas rates of SMM postpartum readmissions decreased significantly among women with GDM by 30 days (APC: −7.44), 60 days (APC: −7.12), and 180 days (APC: −6.37), among women with PDM by 60 days (APC: −7.05), and among women with no diabetes by 30 days (APC: −5.83), 60 days (APC: −5.68), and 180 days (APC: −4.45). Postpartum diabetes-related readmission rates decreased for all periods among women with GDM and without diabetes (APC p values <0.05) and by 180 days among women with PDM (APC: −7.03). Repeated diabetes-related admissions decreased at 60 and 180 days postpartum (APC p values <0.05) among women with PDM. Hypertensive disorders were among the top three reasons for readmissions, regardless of diabetes status.

Conclusion:

Although all-cause readmissions increased by 30 days among women with GDM and without diabetes, postpartum SMM and diabetes-related readmissions decreased overall among women with GDM, PDM, and neither. Hypertensive disorders as a top reason for readmission suggests the need to monitor these disorders among women with GDM and PDM at birth.

Keywords: gestational diabetes, postpartum readmissions, pregestational diabetes

INTRODUCTION

Gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PDM— i.e., diabetes present before pregnancy) are increasing in the United States, affecting 325,000 and 38,093 women in 2020, respectively (Centers for Disease Control and Prevention, 2025; Gregory & Ely, 2023). Diabetes in pregnancy increases the risk of postpartum hospital readmissions (Mourad et al., 2020) and mortality (Murrin et al., 2025), partially due to diabetes-related complications associated with severe maternal morbidity (SMM) and postpartum depression among women with GDM (Azami et al., 2019; Wen et al., 2020) or PDM (Miller et al., 2016; Mourad et al., 2020). Moreover, mental illness was one of the common indications for postpartum hospital readmissions from 2004 to 2011 (Clapp et al., 2016).

While the overall risk of 60-day postpartum hospital readmission was relatively low (1.7%) from 2010-2014 (Wen et al., 2021), it was significantly higher among women with PDM (type 1 diabetes mellitis: 4.4%; type 2 diabetes mellitis: 3.9%) or GDM (2.0%) than among women without PDM or GDM (1.5% risk for readmission) (Mourad et al., 2020). Although the U.S. Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program monitors six specific condition or procedure-related readmissions primarily among older patient populations, there is no standardized metric for calculating risk-adjusted readmission rates following childbirth (Wadhera et al., 2019).

Most studies among women with PDM or GDM have assessed postpartum readmissions up to 60 days of the puerperium period (Mourad et al., 2020; Wen et al., 2020). Readmissions within 30 days of birth may identify those with acute conditions that could have been treated at the original hospitalization. Readmissions within 180 days of birth may identify conditions that could have been treated at outpatient visits. Additionally, almost a third of maternal deaths occur 43-365 days postpartum (Gunja, 2024). Assessing rehospitalization rates for conditions related to diabetes, mental health, SMM (Centers for Disease Control and Prevention, 2024b), and all causes up to 180 days by diabetes status may identify those who could have been cared for in the outpatient setting. In addition, most studies consider only the first hospital readmission, although studies have reported that those with diabetes are at increased risk of multiple readmissions (Everett & Mathioudakis, 2019; Rubin, 2015). Thus, assessing the number of readmissions, not exclusively the first readmission, is warranted. Herein, we examine, stratified by diabetes status: 1) postpartum rehospitalization rates for all causes, SMM, (Centers for Disease Control and Prevention, 2024b), diabetes and mental health conditions; 2) among women with readmissions, the range and average number of readmissions; and 3) the leading cause of readmissions.

MATERIAL AND METHODS

Data Source

We used the Healthcare Cost and Utilization Project (HCUP) National Readmissions Database (NRD), which was developed by the U.S. Agency for Healthcare Research and Quality. The NRD is a publicly available deidentified database containing admission and discharge data from hospitals in 30 geographically dispersed states, accounting for 61.1% of the total U.S. resident population and 60.0% of all U.S. hospitalizations (Agency for Healthcare Research and Quality, 2024). The NRD is designed to support analyses of national readmissions, regardless of the expected payer for the hospital stay. The NRD sampling frame includes hospitals from the HCUP State Inpatient Databases that use reliable, verified patient linkage numbers that can be used to track a person across hospitals within a state. All the discharges in the NRD sampling frame are included, are post-stratified by hospital and patient characteristics, and are then weighted to the total number of discharges in community hospitals (excluding rehabilitation and long-term and acute-care facilities). Community hospitals for the purpose of this study are defined as all nonfederal short-term general and special hospitals, including special children’s hospitals, whose facilities and services are available to the public. Also included are public hospitals and academic medical centers.

Study Population

We selected all women aged 15-44 years who had live births or stillbirths between January 1 and June 30 for each of the years 2016 through 2022. We used the term “women” because, although the administrative records we used do not include information on gender identity, the vast majority of people who have given birth are women. As a result, our study population may not capture transgender or nonbinary people who can become pregnant. We report the years from 2016-2022 because they are the most recent available to us, and data for 2010-2014 have been reported.(Mourad et al., 2020) The postpartum period in each year is defined as the number of days since the delivery discharge (initial discharge). Because the NRD data do not follow individuals across calendar years, we included women who gave birth in the first 6 months of each year to examine up to 180 days postpartum annually and used the same sample of women for the 30- and 60-day analyses. Hospital delivery discharges were identified using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) diagnosis codes or diagnosis-related group (DRG) codes. DRGs comprise a patient classification system that categorizes hospital stays into groups that are clinically similar with respect to resource use, including diagnosis and type of treatment or procedure. Each hospital stay has one DRG assigned to it. From 2016-2017, hospital deliveries were identified by DRG codes 767–768 or 774–775 for vaginal delivery and 765–766 for cesarean section. In 2018, hospital deliveries were identified for DRG Version 35 (DRG codes 767-768 or 774-775 for vaginal delivery and 765-766 for cesarean section) and DRG Version 36 (DRG codes 768, 796-798, or 805-807 for vaginal delivery and DRG codes 783-788 for cesarean section). From 2019-2022, only version 36 DRG codes were used. Index GDM delivery hospitalizations were identified using ICD-10-CM codes O24.4 or O99.81 listed anywhere on the discharge record. ICD-10 codes for pregestational diabetes included E08, E09, E10, E11, E13, O24.0, O24.1, O24.3, O24.8, or O24.9 listed anywhere on the discharge record. Those discharges that listed codes for both GDM and PDM were classified as PDM (Correa et al., 2015). Type 1 diabetes mellitis was defined by ICD-10 code of E10 and type 2 diabetes mellitis was defined by ICD-10 code of E11 reported at delivery. Unknown type of diabetes was defined with any ICD-10 code of E08, E09, or E13, but no E10 or E11 on the discharge record. Women who did not have GDM or PDM ascertained were considered “no diabetes.”

Measures

This retrospective cohort study evaluated postpartum hospital readmissions for three postpartum periods: 1-30 days, 1-60 days, and 1-180 days. Our primary outcome was all-cause readmission, and our secondary outcomes were readmissions for specific indications: 1) diabetes, 2) mental health, and 3) evidence of one or more SMM indicators. Diabetes-related readmissions included those with any ICD-10 code of E08, E09, E10, E11, or E13, regardless of evidence of other causes. Mental health-related readmissions included any ICD-10 code of F01-F99 for mental, behavioral, and neurodevelopmental disorders, regardless of evidence of other causes. SMM was defined using the Centers for Disease Control and Prevention’s criteria, which included ICD-10 diagnosis and procedure codes for 21 indicators (Centers for Disease Control and Prevention, 2024b), regardless of evidence of other causes.

Statistical Analysis

Descriptive statistics were used to characterize the overall study population by diabetes status. The rate of rehospitalizations for each of the four types of readmissions was calculated by diabetes status (GDM, PDM, no diabetes). The denominator was the number of women who gave birth (GDM, PDM, or no diabetes) from January 1 through June 30 of each year. The numerator was the number of women with postpartum readmissions for all causes, SMM, diabetes, or mental health by diabetes status. Thus, rates reported are the number of women with readmissions per 1,000 with deliveries from January 1 through June 30 of each year. The rates are reported for three different postpartum periods, including 30, 60, and 180 days after the date of hospital discharge. The average number of readmissions was calculated among women with postpartum readmissions by diabetes status for each of the four types of readmissions in each of the three postpartum periods. Thus, the average number of readmissions measures repeated admissions per woman who had any readmissions. In other words, “repeated admissions” are the average number of admissions among women who had at least one postpartum readmission. We also report the top reasons (i.e., ICD-10 codes) for hospital readmissions from 2016 through 2022 for each of the three readmission periods.

Data management was performed using SAS 9.4 (SAS Institute Inc.) and SAS-callable SUDAAN 11.0 (RTI International) was used to conduct analyses accounting for the post-stratified study design. We evaluated monotonic regression trends using Joinpoint software, which has the same underlying assumptions as simple regression and allows for input of estimates and standard errors (National Cancer Institute, 2025). We report the annual percent change (APC) from 2016 through 2022 with the level of significance set at p<0.05. This activity was reviewed by CDC, deemed research not involving human subjects, and was conducted consistent with applicable federal law and CDC policy.

RESULTS

The number of women with GDM who gave birth increased significantly from 127,414 in 2016 to 159,790 in 2022 (annual percent change [APC]: 4.34, 95% confidence interval [CI]: 2.22, 6.50) and among women with PDM who gave birth from 20,886 in 2016 to 26,401 in 2022 (APC: 3.53, 95%CI: 1.25, 5.91). The number of women with neither GDM nor PDM who gave birth decreased significantly from 1,660,877 in 2016 to 1,479,445 in 2022 (APC: −2.04, 95%CI: −2.32, −1.76).

All-Cause Readmissions

Rates (i.e., number per 1,000 women giving birth) of all-cause readmissions among women with GDM as well as women without diabetes increased through 30 days postpartum (APC: 2.78 for both) significantly from 2016 to 2022. (Figures 1a and 3a) All-cause readmissions decreased among women with PDM overall, and for those with type 2 diabetes though 180 days postpartum during the same time period (APC: −4.36 and APC: −2.72, respectively). (Figures 2a. and 2.2.a)

Figure 1.

Figure 1.

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Trends of Postpartum Hospital Readmissions per 1,000 Women with Gestational Diabetes, U.S. 2016-2022

*Indicates statistically significant change during study period.

Includes readmissions with the 21 Severe Maternal Morbidity (SMM) indicators, diabetes (E08-E13), or mental health related conditions (F01-F99) reported anywhere in the list of up to 40 ICD codes per admission.

Figure 3.

Figure 3.

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Trends of Hospital Readmissions per 1,000 Women without a Gestational Diabetes or Pre-Gestational Diabetes Diagnosis, U.S. 2016-2022

*Indicates statistically significant change during study period.

Includes readmissions with the 21 Severe Maternal Morbidity (SMM) indicators, Diabetes (E08-E13), or mental health related conditions (F01-F99) reported anywhere in the list of up to 40 ICD codes per admission

Figure 2.

Figure 2.

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Trends of Postpartum Hospital Readmissions per 1,000 Women with Pre-Gestational Diabetes, U.S. 2016-2022

*Indicates statistically significant change during study period.

Includes readmissions with the 21 Severe Maternal Morbidity (SMM) indicators, diabetes (E08-E13), or mental health related conditions (F01-F99) reported anywhere in the list of up to 40 ICD codes per admission.

Figure 2.2.

Figure 2.2.

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Trends of Postpartum Hospital Readmissions per 1,000 Women with Type 2 Diabetes, U.S. 2016-2022

*Indicates statistically significant change during study period.

Includes readmissions with the 21 Severe Maternal Morbidity (SMM) indicators, Diabetes (E08-E13), or mental health related conditions (F01-F99) reported anywhere in the list of up to 40 ICD codes per admission

The APC from 2016 to 2022 in average number (i.e., multiple readmissions per person with any readmissions) of all-cause readmissions decreased when measured through 30 days among women with unknown diabetes type (APC: −1.45) and no diabetes (APC: −0.15) and when measured through 60 days among women with GDM (APC: −0.40), with PDM (APC: −1.25), and without diabetes (APC: −0.26). Rates also decreased when measured through 180 days among women with GDM (APC: −0.58) and without diabetes (APC: −0.46) (Supplemental Tables).

SMM Readmissions

SMM readmissions decreased significantly when measured through 30, 60, and 180 days postpartum among women with GDM (30 days APC: −7.44; 60 days APC: −7.12; 180 days APC: −6.37) and without diabetes (30 days APC: −5.83; 60 days APC: −5.68; 180 days APC: −4.45); SMM readmission rates decreased among women with PDM through 30 days (APC: −7.05) (Figures 1b, 2b, and 3b).

The APC from 2016 to 2022 in repeated SMM admissions increased through 30 days among women with GDM (APC: 0.26) and 60 days among women with GDM (APC: 0.33) and type 2 diabetes (APC: 0.91) (Supplemental Tables).

Diabetes-related Readmissions

Diabetes-related readmissions decreased significantly when measured through 30, 60 and 180 days postpartum among women with GDM (30 days APC: −23.82; 60 days APC: −22.16; 180 days APC: −16.04) and without diabetes (30 days APC: −33.50; 60 days APC: −33.44; 180 days APC: −29.73). Diabetes-related readmission rates decreased among women with PDM and with type 2 diabetes through 180 days (APC: −7.03 and APC: −4.73, respectively) (Figures 1c, 2c, 2.2c, and 3c). Among women with unknown diabetes type, diabetes-related readmissions decreased through 30 days (APC: −7.05) and 180 days (APC: −5.74) (Figure 2.3c).

Figure 2.3.

Figure 2.3.

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Trends of Hospital Readmissions per 1,000 Women with Unknown Diabetes Type, U.S. 2016-2022

*Indicates statistically significant change during study period.

Includes readmissions with the 21 Severe Maternal Morbidity (SMM) indicators, Diabetes (E08-E13), or mental health related conditions (F01-F99) reported anywhere in the list of up to 40 ICD codes per admission

The APC from 2016 to 2022 in repeated diabetes-related admissions decreased through 60 days among women with PDM (APC: −1.18) and 180 days among women with PDM (APC: −1.65) and type 2 diabetes (APC: −1.59) (Supplemental Tables).

Mental Health-related Readmissions

Mental health-related readmissions decreased through 60 days among women with PDM (APC: −5.42), and through 180 days among women with type 2 diabetes (APC: −3.81) and without diabetes (APC: −2.70) (Figures 2d, 2.2d, and 3d).

The APC from 2016 to 2022 in repeated mental health-related admissions decreased through 180 days among women without diabetes (APC: −0.25) (Supplemental Tables).

No significant changes during the study period were noted among women with type 1 diabetes for any of rates of readmissions or rates of repeated admissions.

Top ICD Codes (Reasons) for Readmissions

For some consecutive years noted below, the top three reasons were the same and are reported accordingly. Among women with GDM in 2016, the most frequently reported reason for readmissions was 1) other complications of the puerperium, followed by 2) infection of obstetric surgical wound and 3) endometritis following delivery. Among women with PDM in 2016, the top two reasons for postpartum hospital readmissions when measured through 30 and 60 days were the same — 1) infection of obstetric surgical wound and 2) other complications of the puerperium — but the third differed: by 30 days it was eclampsia complicating the puerperium and by 60 days it was puerperal sepsis. Among women without GDM or PDM in 2016, the top three reasons for postpartum hospital readmissions were the same when measured through 30, 60, and 180 days: 1) other complications of the puerperium, 2) endometritis following delivery, and 3) infection of obstetric surgical wound.

For 2017 and 2018, the top three reasons for hospital readmissions among women with GDM were the same when measured through 30, 60, and 180 days: 1) severe preeclampsia, 2) unspecified preeclampsia, and 3) infection of obstetric surgical wound. For 2019-2022, the top three reasons for hospital readmissions among women with GDM were the same for all years at 30, 60, and 180 days: 1) severe preeclampsia, 2) unspecified preeclampsia, and 3) preexisting hypertension with preeclampsia. Of note, diabetes-related conditions were not among the top reasons for readmissions for women with GDM. Among women with PDM, from 2016 through 2021 by 180 days the top reason was type 1 diabetes with ketoacidosis without coma, but the second and third reasons varied across years. From 2019-2022 severe pre-eclampsia and pre-existing hypertension with pre-eclampsia were among the top three reasons among women with PDM for readmissions when measured through 30, 60, and 180 days. From 2017 to 2022, the top three reasons for postpartum hospital readmissions among women without diabetes were the same when measured through 30, 60, and 180 days: 1) severe preeclampsia, 2) unspecified pre-eclampsia, and 3) endometritis following delivery.

DISCUSSION

The rate of all-cause readmissions increased by the same annual percentage change during our study period among women with GDM as that among women without diabetes at 30 days, though the absolute rates of readmissions were higher among women with GDM. The rates of SMM and diabetes-related postpartum readmissions declined among women overall with GDM, PDM, and neither; additionally, rates of mental health-related readmissions declined among women with PDM. Notably, among women with PDM, decreases in readmission rates were only observed among women with type 2 diabetes, except for diabetes-related readmissions among women with unknown diabetes type. The decrease in SMM and diabetes-related readmission rates among women with GDM and PDM may have resulted from improvements in postpartum care as recommended by the American College of Obstetricians and Gynecologists (ACOG). In 2018, ACOG published a Committee Opinion on optimizing postpartum care to reinforce the importance of the “fourth trimester,” involving earlier and more frequent contacts and aiming to support patients’ longer-term well-being (e.g., by managing chronic physical conditions and mental illness) (“ACOG Committee Opinion No. 736: Optimizing Postpartum Care,” 2018). Given the urgent need to reduce SMM and maternal mortality, recommendations urged that women with chronic conditions such as GDM and PDM be counseled and treated for prevention of complications, including glucose screening (ACOG Committee Opinion No. 736: Optimizing Postpartum Care, 2018). A review of studies found postpartum visit attendance to be approximately 70% among women with diabetes (Attanasio et al., 2022). Notably, we found that among women with GDM, all-cause readmissions increased at 30 days and women who were readmitted for any reason were less frequently admitted repeatedly for any reason at 60 and 180 days. Although fewer women with GDM had postpartum readmissions for SMM, those who were readmitted for SMM were admitted repeatedly (multiple times) more frequently by 30 and 60 days for SMM during our study period. Those who were admitted repeatedly may have had comorbid conditions such as hypertension, which has increased among women with GDM (Bardenheier, Imperatore, Gilboa, et al., 2015) and was among the top reasons for readmissions during our study period. Women with PDM who had readmissions were also less frequently admitted repeatedly for any reason at 60 days, and for diabetes-related reasons at 60 and 180 days. The recommendation that postpartum care conclude with a comprehensive postpartum visit no later than 12 weeks after birth, including a full assessment of physical, social and psychological well-being (ACOG Committee Opinion No. 736: Optimizing Postpartum Care, 2018), may have helped in reducing repeated all-cause admissions among women with GDM or PDM at 60 and 180 days.

Also notable, rates of expedited postpartum discharge increased significantly in 2020 compared with 2016–2019, likely due to the COVID-19 pandemic (Walia et al., 2024). Routine postpartum discharge generally occurs 2 days after vaginal delivery and 3 days after cesarean; earlier discharge is expedited. Benefits of expedited discharge include decreased risk of nosocomial infections in the hospital, improved family bonding, and potential cost savings in care provided (Kiely et al., 1998). Expedited postpartum discharge was associated with 14% lower adjusted odds of 60-day postpartum readmission compared with routine discharge (Walia et al., 2024). This may in part have contributed to the decrease in readmissions as well as multiple readmissions by 60 days postpartum among women without GDM or PDM.

The decline in diabetes-related postpartum hospital readmissions among women without a GDM or PDM diagnosis may be due to either the ICD version 9 to 10 transition that occurred in October 2015 in the United States (Khera et al., 2018) or to undiagnosed GDM or PDM at delivery. The decline may also be that the incidence of diabetes within a few months of giving birth may be truly decreasing, reflecting a population at lower risk. Even so, these readmissions within 6 months of giving birth (< 200 cases among roughly 800,000 women per year [0.25 cases per 1,000 women giving birth]) were lower than those in studies that followed women with and without GDM after giving birth in 1985-1986 for up to 20 years to identify incident diabetes cases (4.5 per 1,000 person-years) (Gunderson et al., 2007). This decline in readmissions may also be due to improved postpartum care or care provided in the outpatient setting. By the beginning of our study period, 30 states had expanded Medicaid coverage to adults with incomes of up to 138% of the federal poverty level under the Affordable Care Act, and adults with higher incomes had gained the option to purchase individual policies (with premium subsidies for those with incomes below 400% of the federal poverty level) from marketplaces (Congress.Gov, 2021; KFF, 2025). Medicaid expansion has been shown to reduce maternal morbidity and mortality, likely through improved postpartum access to care and improved interpregnancy care (Luther et al., 2021). This may also have contributed to the decrease in rates of repeated admissions for any reason at all time points (30, 60, 180 days), and at 180 days for mental health-related readmissions.

Although rates of mental health-related postpartum readmissions did not change among women with GDM, studies have shown substantial geographic and racial differences in postpartum readmissions for mental health disorders; for instance, rural and Black women are at higher risk for both mental health disorders (Hung et al., 2024) and GDM (Centers for Disease Control and Prevention, 2024a; Venkatesh et al., 2024). This may suggest the need for monitoring of racial differences in postpartum readmissions among women with GDM.

Also notable, no changes were observed in any readmission rates nor in repeated admissions among women with type 1 diabetes. This may reflect a gap in quality of care that should also be recognized and addressed through improved postpartum care. Also observed in our study was a difference in top ICD codes reported in 2016 from the other years. Although we cannot be certain, it may be due to the change in coding from the change from ICD-9 to ICD-10 in the preceding year (Khera, 2018).

Hypertensive disorders were one of the top two reasons for readmissions at 30 and 60 days from 2017-2022 among women with GDM and from 2019-2022 among women with PDM. In a previous study assessing comorbid hypertensive disorders among women with GDM and PDM who gave birth, the proportions increased statistically significantly from 2000 to 2010 (Bardenheier, Imperatore, Devlin, et al., 2015; Bardenheier, Imperatore, Gilboa, et al., 2015). This suggests there may be a need for monitoring of pre-existing hypertensive disorders among women with GDM and PDM.

A limitation of this study was that given the design of the NRD, we were only able to follow readmissions within a calendar year; thus, this analysis likely underestimates the rates of readmissions in patients who were admitted in the second half of the calendar year and may mask seasonal variation in readmission trends. Also, the lack of a consistent patient identifier across calendar years prevented us from assessing unique patients admitted across the study period. In addition, there may be misclassification of type of diabetes by using the ICD codes, though one study found ICD-10 codes to be accurate for identifying type 1 diabetes before age 20 (Chi et al., 2019). Finally, we were unable to obtain data past 2022 to assess more recent changes.

CONCLUSIONS

Findings from our examination of postpartum readmissions among those with GDM, PMD, and neither suggest declines in SMM, diabetes-related, and to some extent mental health-related postpartum readmissions. These declines may have resulted from improvements in postpartum care for all women, possibly associated with coverage expansion and ACOG recommendations for postpartum care. Yet the increase in 30-day readmissions among women with GDM and women without diabetes suggests that other reasons for readmissions during that time period for those women should be further investigated. Because we found that pre-eclampsia was among the top reasons during that follow-up time for those groups, it likely plays a role. We also found that the incidence of diabetes within a few months of giving birth may be decreasing, or more diabetes care is being provided in the outpatient setting.

IMPLICATIONS FOR PRACTICE AND/OR POLICY

Because hypertensive disorders were one of the top two reasons for readmissions, and previous studies reported an increase in comorbid hypertensive disorders among women with GDM and PDM (Bardenheier, Imperatore, Devlin, et al., 2015; Bardenheier, Imperatore, Gilboa, et al., 2015), it may be beneficial to monitor hypertensive disorders among women with GDM and PDM at birth and postpartum. Postpartum readmissions will always be necessary when clinically appropriate. However, improved postpartum care and management and treatment may help to prevent some readmissions.

Supplementary Material

1

Figure 2.1.

Figure 2.1.

Open in a new tab

Trends of Postpartum Hospital Readmissions per 1,000 Women with Type 1 Diabetes, U.S. 2016-2022

*Indicates statistically significant change during study period.

Includes readmissions with the 21 Severe Maternal Morbidity (SMM) indicators, Diabetes (E08-E13), or mental health related conditions (F01-F99) reported anywhere in the list of up to 40 ICD codes per admission

Funding:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Biographies

Barbara H Bardenheier, PhD, MPH, MA, is an Epidemiologist, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

Ibrahim Zaganjor, PhD, is an Epidemiologist at the U.S. Centers for Disease Control and Prevention.

Kai McKeever Bullard, PhD, is a Senior Epidemiologist, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

Jean M. Lawrence, ScD, MPH, MSW, FACE, is the Senior Advisor for Diabetes Epidemiology in the Division of Diabetes, Endocrinology, and Metabolic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health.

Christopher S. Holliday, PhD, MPH, MA, FACHE, is the Director of the Division of Diabetes Translation, specializing in public health leadership and epidemiology, in the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

Oscar Rincón-Guevara, PhD, is a Senior Data Scientist with expertise in data analytics and machine learning applied to public health, within the Office of Public Health Data Surveillance and Technology at the Centers for Disease Control and Prevention.

Holly Du, MPH, CPH, CHES, is an Application Programmer at the U.S. Centers for Disease Control and Prevention.

Dayna S. Alexander, DrPH, MSPH, MCHES, is a Senior Health Scientist in the Division of Diabetes Translation at the Centers for Disease Control and Prevention. She leads mixed-methods research and evaluation informing programs, policies, and practices with expertise in community engagement.

Catherine Barrett, PhD, is a Health Scientist, Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

Osatohamwen I. Idubor, MD, MHS, CHES, Commander, United States Public Health Service is the Chief Medical Officer of the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention.

Footnotes

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Duality of Interest

No potential conflicts of interest relevant to this article were reported.

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