Only thirteen percent received all recommended tests
In the quiet aftermath of birth, when a woman's body is still rewriting itself, a new Columbia University study reveals that most postpartum women diagnosed with diabetes are left without the blood sugar monitoring their condition demands — and Black women bear this silence most heavily. Researchers tracking over five thousand New York City mothers found that only thirteen percent received the twice-yearly A1C testing recommended by clinical guidelines, exposing a vast distance between medical knowledge and medical care. The study, published in the British Medical Journal, asks an old and urgent question: for whom does the healthcare system actually work, and at what cost to those it leaves behind.
- Only one in eight postpartum women with newly diagnosed diabetes receives the biannual A1C monitoring that guidelines require, leaving the vast majority without a basic tool for preventing serious complications.
- Black women face both lower testing rates and longer delays before their first follow-up test, compounding health disparities that already place them at greater risk for diabetes and its consequences.
- Women raising multiple children experience measurable delays in care, suggesting that the competing demands of motherhood itself become a structural barrier to managing a chronic disease.
- In a counterintuitive finding, Medicaid-insured women outperformed those with private insurance on follow-up testing, hinting that coordinated care supports may matter more than coverage type alone.
- Researchers are calling for targeted interventions addressing social determinants — transportation, care coordination, insurance continuity — to close gaps before silent complications take hold.
A Columbia University study has found that the overwhelming majority of women who develop diabetes after childbirth are not receiving the blood sugar monitoring their doctors recommend — and the shortfall falls hardest on Black women.
Analyzing more than five thousand five hundred women in New York City who were diagnosed with postpartum-onset diabetes between 2009 and 2016, researchers linked birth records, hospital data, and A1C test registries to measure how consistently women received follow-up care. The American Diabetes Association recommends A1C testing at least twice a year for patients with stable type 2 diabetes, as the test tracks average blood glucose over three months and is a primary predictor of whether complications will develop. Only thirteen percent of the women studied met that standard — a striking gap between clinical guidance and lived reality.
Led by doctoral student Natalie Boychuk at Columbia's Mailman School of Public Health, the study examined how race, insurance status, education, and number of children shaped both the timing and frequency of testing. Non-Hispanic Black women were significantly less likely to receive timely follow-up and had lower overall testing rates than non-Hispanic White women, even after adjusting for factors like age and body mass index. Women with multiple children also waited longer for their first test and received fewer tests overall — a pattern that points to the invisible weight of caregiving as a barrier to self-care.
One finding cut against expectations: women covered by Medicaid at delivery were more likely to receive earlier and more frequent testing than those with private insurance. The researchers suggest that care coordination services bundled with Medicaid may help women stay engaged with their diabetes management in ways that private coverage does not, and they flag this finding as worthy of deeper investigation.
The consequences of these gaps are not abstract. Without regular monitoring, women cannot know whether their blood sugar is controlled, and cardiovascular disease, kidney damage, and vision loss can develop without warning. Black women — who already face higher rates of diabetes and worse outcomes — are disproportionately denied the routine monitoring that could interrupt that trajectory. The researchers call for targeted interventions addressing the social and structural barriers that keep postpartum women from accessing care, arguing that closing these gaps could meaningfully improve long-term cardiometabolic health and reduce the racial disparities that currently define diabetes outcomes.
A new study from Columbia University has found that most women who develop diabetes after giving birth are not receiving the blood sugar monitoring their doctors recommend—and the problem is especially acute for Black women.
Researchers analyzed five thousand five hundred ninety women in New York City who delivered babies between 2009 and 2016 and were subsequently diagnosed with postpartum-onset diabetes. Using linked birth certificates, hospital discharge records, and A1C test registries, they tracked whether these women received the follow-up care considered essential for managing their condition. The American Diabetes Association recommends that patients with stable type 2 diabetes have their A1C tested at least twice a year. A1C measures average blood glucose over a three-month period and serves as a cornerstone of diabetes management, strongly predicting whether complications will develop.
The findings were stark. Only thirteen percent of the women in the study received all the biannual A1C tests recommended during their follow-up period. This represents a massive gap between clinical guidance and what actually happens in practice. The researchers, led by doctoral student Natalie Boychuk at Columbia's Mailman School of Public Health, examined how social determinants of health—factors like race, insurance status, education, and the number of children a woman has—shaped whether women got tested and how quickly they received their first test after diagnosis.
Racial disparities emerged clearly. Non-Hispanic Black women were significantly less likely to receive timely follow-up testing and had lower overall testing rates than non-Hispanic White women. Women with multiple children also experienced longer delays before their first test and received fewer tests overall. The pattern held even after researchers adjusted for factors like body mass index, gestational diabetes history, and age. This is the first research to examine how social determinants specifically shape access to A1C testing in the postpartum period—a time when new mothers face distinct barriers to care, from competing demands on their time to gaps in insurance coverage or transportation.
One finding surprised the researchers: women covered by Medicaid at the time of delivery were more likely to receive earlier follow-up testing and had higher overall testing rates than those with private insurance or other coverage. This counterintuitive result suggests that the supports bundled with Medicaid—case management, care coordination, or other services—may help women stay engaged with their diabetes care in ways that private insurance does not. The researchers note this advantage warrants further investigation.
The stakes of these gaps are substantial. Postpartum diabetes is increasingly common among women of reproductive age, yet the follow-up care after diagnosis remains poorly understood and inadequately delivered. Without regular monitoring, women cannot know whether their blood sugar is controlled, and complications—cardiovascular disease, kidney damage, vision loss—can develop silently. The disparities documented here mean that Black women, who already face higher rates of diabetes and worse outcomes, are also less likely to receive the routine monitoring that could prevent those complications.
The researchers call for targeted interventions that address the social and structural barriers preventing women from accessing A1C tests. Better engagement of reproductive-aged women in routine diabetes monitoring during the postpartum period, they argue, could improve long-term cardiometabolic health and reduce the racial disparities that currently shape diabetes outcomes. The study was published in the British Medical Journal.
Notable Quotes
Our findings reveal disparities by race and ethnicity, insurance, and parity—and show that most women are not meeting recommended testing intervals.— Natalie Boychuk, doctoral student in Epidemiology at Columbia Mailman School
Improving access to and uptake of A1C testing in the postpartum period could help improve long-term cardiometabolic health and reduce disparities in diabetes outcomes.— Teresda Janevic, associate professor of Epidemiology at Columbia Mailman School of Public Health
The Hearth Conversation Another angle on the story
Why does the postpartum period matter so much for diabetes monitoring? Couldn't this be a problem at any time?
The postpartum period is uniquely vulnerable. Women are recovering from pregnancy and birth, managing a newborn, often returning to work or juggling childcare. Their attention is fractured. And the research shows that if you don't catch and monitor diabetes early, the damage compounds over years.
The Medicaid finding is strange—usually we see Medicaid patients getting worse care, not better. What's happening there?
That's the real puzzle. It suggests that the infrastructure around Medicaid—the case managers, the care coordination, the safety-net systems—might actually be doing something right that private insurance isn't. Or maybe it's simpler: Medicaid patients have fewer options, so they go to the same clinic repeatedly and build relationships with providers who track them.
Why are Black women specifically falling through the cracks?
The study doesn't answer that directly, but the pattern is consistent with what we know about structural racism in medicine. It could be implicit bias from providers, it could be that Black women face more barriers to getting time off work for appointments, it could be that they're less likely to be referred for follow-up care in the first place. The data shows the disparity; the mechanisms are still hidden.
Does having more children make it harder to get tested?
Yes, and that makes sense. Each additional child means more competing demands. You're managing schedules, transportation, childcare during appointments. The study found both longer delays to the first test and lower overall testing rates for women with more children.
What happens if a woman never gets tested?
Her diabetes goes unmonitored. She doesn't know if her blood sugar is controlled. Over time, high blood sugar damages blood vessels and nerves silently—heart disease, kidney failure, blindness. By the time symptoms appear, the damage is often irreversible.