Voices of U of U Health
Bridging Gaps in Women’s Health: From Pregnancy to Long-Term Prevention
In this multi-part blog series, researchers at the University of Utah College of Nursing share new insights that are expanding our understanding of women’s health. This first installment shows how rethinking postpartum care, addressing social needs, and partnering with communities can help prevent disease and improve women’s health long before complications arise.
By Sara Simonsen, PhD, CNM MSPH, BSN
Why don’t researchers know as much about women’s health as they do about lung cancer or heart disease? Because historically, women were largely excluded from medical research, so conditions that only affected women weren’t well studied. Researchers who were hesitant to study women were even less likely to include pregnant women.
It’s a legacy we’re still grappling with when it comes to understanding sex-specific manifestations of illness. For example, women may think they aren't having a heart attack unless they have crushing chest pain, although women are less likely to have this common male symptom. Mannequins used for CPR training don’t have breasts or bras, and some data shows that women are less likely to receive CPR. A woman’s risk of heart disease may correlate with the severity of her hot flashes, but evidence is just beginning to emerge.
As a labor and delivery nurse, I routinely saw patients with gestational diabetes, preeclampsia, and preterm birth and wondered if some complications could be prevented earlier in pregnancy or even before pregnancy. That motivated me to study public health and make prevention a focus of my research.
Detecting Diabetes Risk After Gestational Diabetes
Pregnancy can be viewed as a crystal ball for a woman’s future health. Within a decade of the onset of gestational diabetes, for example, 50% of women will develop type 2 diabetes. Unfortunately, they don’t always know they are at risk. Some women get pregnant again with undetected diabetes, which raises the risk of birth defects and the child’s risk of developing diabetes later in life.
In collaboration with colleagues at the University of Kentucky, I’m working to understand the postpartum transition for women with gestational diabetes and how to optimize care during this critical window. Although health care providers recommend a postpartum oral glucose tolerance test to show if blood sugar levels have returned to normal, our research found that only 17% of women complete the test. We interviewed women and surveyed providers to find out why.
Some women mistakenly believed that gestational diabetes resolved after pregnancy. Others didn’t want to drink the sugary beverage or had no time for a two-hour test. And fewer than half of postpartum women said that their providers discussed their type 2 diabetes risk, so they didn’t realize the importance of testing.
Providers said that the electronic health record (EHR) didn’t prompt them to schedule testing for women upon discharge or generate automatic reminders when women were overdue for testing. Very few providers referred patients to resources like the National Diabetes Prevention Program, which cuts diabetes risk in half.
We’re developing potential solutions, including a mechanism for flagging women with gestational diabetes in the EHR, so providers refer them for testing. And sending women automated reminders about testing or missed appointments. Changes like these could have significant impact. Diagnosing type 2 diabetes early can improve a woman’s long-term health and her health during future pregnancies.
Unmet Social Needs Lead to Higher Pregnancy Complications
Research shows that meeting women’s social needs, like food insecurity, can decrease risk of pregnancy complications like gestational diabetes, preterm labor, and babies needing NICU care.
At University of Utah Health, we screen pregnant women for social needs. We ask them about their access to food, housing, transportation, and their ability to pay for rent, utilities, medication, and clothing. If someone has one or more unmet social need, we ask if they want to be connected to 211, United Way. 211 provides resources and connections to services that improve pregnancy outcomes. Among 8,000 pregnant women screened, about 25% had one or more unmet social need, but only a fraction received 211 assistance.
I’m comparing birth outcomes of women with and without unmet social needs, to see if there were improved outcomes among women who were contacted by 211. More research will determine if there is a positive association.
Identifying Barriers to Sleep
Poor sleep is a risk factor for diabetes, hypertension, and cardiovascular disease. With my colleagues Kelly Baron, PhD, MPH, DBSM and Ivette López, PhD, MPH, I’m examining whether social determinants of health affect sleep among Hispanic, Black/African American, Native American, and African women.
In these communities, which are often overlooked by researchers, we’re trying to understand the barriers to healthy sleep. We’re studying women’s use of time to see how they might balance activities to provide more time for sleep. Our research has shown that some women have multiple work and family commitments. We plan to develop a tailored intervention to promote healthy sleep that is mindful of their experiences.
Partnering With Community Leaders
Nurturing relationships with community health workers (CHWs) and community advisory boards makes my research possible.
CHWs are trusted providers of health information to women in their communities. They recruit study participants and deliver health interventions that we create. Community advisory boards share culturally relevant perspectives, helping us collect better data.
These relationships are key to helping researchers like me fill research gaps, leading to better short-term and long-term health for women.
