Mindi Rosen met Seuli Brill, MD, at just the right time.
Rosen's firstborn son was in the neo-intensive natal unit at The Ohio State University Wexner Medical Center in Columbus, and she didn't have a pediatrician picked out yet for the baby. Nor did she have a primary care physician who could help her manage the gestational diabetes she developed during her pregnancy.
Brill, a clinical associate professor of internal medicine and pediatrics at Ohio State, suggested Rosen visit her at the new clinic she was piloting in Columbus. There, she provided pediatric care for newborns and primary care for mothers who had developed gestational diabetes.
"I looked at my husband, my husband looked at me, and I said: 'Why not?' " Rosen, 38, recalled of that 2019 meeting. "I'm so glad she walked in at that moment."
The mother of two is still part of the rapidly growing program at the medical facility that provides care for more than 200 mothers and babies.
Launched in 2018, the clinic — called the Multi-Modal Maternal Infant Perinatal Outpatient Delivery System, or "Momi Pods," started with a focus on helping women with gestational diabetes, which occurs in up to 10% of pregnancies.
The program allows moms to book regular checkups for their baby, and then a follow-up appointment immediately after for themselves. Women are seen for the first 1000 days (just under 3 years) after giving birth.
The idea was simple. Brill wanted to develop a more formalized program for the work she was already doing as a primary care physician and pediatrician. At the time, she was fielding referrals from specialists for young women who didn't have a physician. She'd often develop a relationship with the patient over the years, go on to help oversee their care during pregnancy, then new mothers would select her as their newborn's pediatrician.
"I would have a relationship with the mom when they did have the newborn, and then I would see the baby because I'm a pediatrician," Brill said.
Brill was serving on the Ohio Gestational Diabetes Mellitus Collaborative, a state-backed program that aims to raise awareness about the condition and encourage more preventative care for patients. She presented her proposal to launch the program to the Ohio Department of Medicaid, which helped to fund the pilot.
The idea, she hoped, would improve postpartum follow-up care for mothers diagnosed with the condition.
Follow-up care is especially important for women who develop gestational diabetes because the condition raises their lifetime risk of developing type 2 diabetes up to 10-fold.
Yet most of those mothers don't get the appropriate follow-up care during the crucial postpartum period, said Maya Subbalakshmi Venkataramani, MD, MPH, an assistant professor of medicine at Johns Hopkins University in Baltimore, who has researched parental care.
"Things get very busy after you have a child. There's just the general logistics of a mom having to take care of a newborn and thinking about themselves," Venkataramani, a primary care clinician and pediatrician, said. "A lot of parents in general may not put a lot of emphasis on their own health."
Seeking care may be especially difficult for low-income mothers who might not have consistent healthcare coverage, she added.
In fact, only half of women who developed gestational diabetes received primary follow-up care, according to a study published earlier this month in JAMA Network Open. The study, which examined more than 280,000 insurance claims between 2015 and 2018, found only 36% of women with gestational diabetes received the recommended blood glucose testing in the first 12 weeks of the postpartum period.
In the Momi Pods program, Brill checked in on Rosen's gestational diabetes regularly during pediatric office visits for her newborn's care. Rosen said whenever she brought her baby in for a visit during the postpartum period, Brill measured her blood sugar.
Brill and her team also asked how Rosen was doing physically and mentally during each visit. The screenings helped to catch a bout of postpartum depression Rosen experienced after the birth of her first son.
"I thought it was great, because honestly as a new mom I wouldn't have followed up with myself so much," Rosen said. "Every time you went into the doctor appointments, they'd ask you how you are doing. As a new mom, it's so much easier to do it at the same time."
Those who participate in the program are also more likely to complete postpartum visits with their ob/gyn (95% vs 58%, respectively; P < .001) than those who don't participate, according to research Brill and colleagues published last year.
Brill began expanding the program's reach nearly 2 years after its launch, targeting the services for women who are at risk for poor postpartum outcomes, including those with a history of depression, preterm labor, diabetes and congenital heart disease. Ob/gyns in Ohio State's network can refer their patients to the program, which now has 43 doctors trained to provide primary and pediatric care through Momi Pods. Soon-to-be moms can be referred to the program as early as the second trimester, Brill said.
Many of the mothers referred to the program don't have a primary care clinician when they talk to Paola Beamon, RN, at Ohio State. Beamon reaches out to each referred patient over voicemail, a MyChart message, and even regular mail in hopes of helping them navigate the postpartum period. She also provides education on what a primary care clinician can offer new moms.
"Really, we're pursuing these moms and doing everything we can so there's less of a burden for them," Beamon said. "A lot of them don't even know what a primary care office does."
One of the biggest perks to the program for new moms is that they don't have to spend time and money traveling to a different doctor's office, take time off work, or secure childcare in order to schedule a separate appointment for themselves, she said.
The program, which receives funding from the university and the state, even helps women get bus passes to a doctor's appointment if needed.
Dyad programs targeting women with substance abuse disorders or mental health conditions have existed for many years. But catering to women with gestational diabetes or other medical conditions appears to be new. In part, Venkataramani said, because scheduling and space can be big hurdles to launch such a program, as well as finding doctors who can care for both baby and mother.
"There are logistical challenges to even doing this that makes it less common," she said.
Brill said she is not aware of any other programs that are structured like the tandem care clinic at Ohio State. She hopes, however, that the program can be a model for other hospital systems to consider, and she is working to expand the program regionally. Her team is collecting data — including on the best way to schedule patients — to help other clinics develop something similar.
"We really want to leverage that expertise to make it easier for moms to get care with their infants and remove barriers to care," she said.
Amanda Schmidt is a journalist living in Virginia.
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Cite this: Are 'Momi Pods' the Future of Postnatal Care? - Medscape - Feb 16, 2023.
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