{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T12:40:02Z","timestamp":1772541602898,"version":"3.50.1"},"reference-count":31,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T00:00:00Z","timestamp":1755993600000},"content-version":"unspecified","delay-in-days":54,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Department of Obstetrics, Gynecology and Women\u2019s Health, University of Minnesota","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["P30 CA77598"],"award-info":[{"award-number":["P30 CA77598"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"National Center for Advancing Translational Sciences of the National Institutes of Health","award":["UM1TR004405"],"award-info":[{"award-number":["UM1TR004405"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2025,7,30]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Early birth is often recommended for \u201cpoorly controlled\u201d diabetes; however, no guidelines define the glycemic threshold that necessitates delivery. We use natural language processing (NLP) of electronic health records to identify individuals described by healthcare professionals as having \u201cpoor glucose control\u201d and to examine the factors and outcomes associated with this categorization<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Research design and methods<\/jats:title>\n                  <jats:p>We completed a retrospective cohort study of pregnant individuals with pre-existing and gestational diabetes mellitus from 2018 to 2019. NLP identified prespecified terms indicating \u201cpoor glucose control\u201d in clinical notes, and a cohort analysis compared those with and without \u201cpoor glucose control\u201d language. Clinical characteristics, objective glucose measures, and neonatal and maternal outcomes were statistically compared.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>1433 individuals met inclusion criteria, and 143 (10%) were described as having \u201cpoor glycemic control.\u201d After adjusting for diabetes type, pregnant individuals of color (adjusted OR (aOR) 2.4, 95%\u2009CI 1.63 to 3.57, p&lt;0.001), individuals on public insurance (aOR 3.22, 95%\u2009CI 2.2 to 4.74, p&lt;0.001), and non-English\/non-Spanish speaking individuals (aOR 2.07, 95%\u2009CI 1.22 to 3.4, p=0.005) had higher odds of being categorized as having \u201cpoor glucose control\u201d than control groups. This designation was often applied in the absence of objective markers of glycemia. While some individuals categorized with \u201cpoor glucose control\u201d experienced earlier births and higher rates of neonatal complications, these differences were less pronounced when comparing individuals with A1c\u22646.5%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Pregnant individuals of color, those on public insurance, and non-English\/non-Spanish speakers are more likely to be categorized as having \u201cpoor glycemic control.\u201d Little objective data supported this categorization.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjdrc-2025-005197","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T01:35:19Z","timestamp":1756085719000},"page":"e005197","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Healthcare professional classification of \u201cpoor glucose control\u201d and perinatal outcomes in pregnancies with diabetes: a retrospective cohort study"],"prefix":"10.1136","volume":"13","author":[{"given":"Anwei","family":"Gwan","sequence":"first","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isai","family":"Ortiz","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5513-583X","authenticated-orcid":false,"given":"Katelyn M","family":"Tessier","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renee","family":"Mahr","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Ayers Looby","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjana","family":"Molleti","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Makori","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwabukola","family":"Akingbola","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sereen","family":"Nashif","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u2019Mag","family":"Karbeah","sequence":"additional","affiliation":[{"name":"University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6894-7837","authenticated-orcid":false,"given":"Sarah A","family":"Wernimont","sequence":"additional","affiliation":[{"name":"Obstetrics, Gynecology and Women\u2019s Health, University of Minnesota, Minneapolis, Minnesota, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,24]]},"reference":[{"key":"2025082418351359000_13.4.e005197.1","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.15585\/mmwr.mm6743a2","article-title":"Prevalence and Changes in Preexisting Diabetes and Gestational Diabetes Among Women Who Had a Live Birth - United States, 2012-2016","volume":"67","author":"Deputy","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025082418351359000_13.4.e005197.2","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1038\/s41372-019-0516-5","article-title":"The association of pregestational and gestational diabetes with severe neonatal morbidity and mortality","volume":"40","author":"Battarbee","year":"2020","journal-title":"J Perinatol"},{"key":"2025082418351359000_13.4.e005197.3","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-067946","article-title":"Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis","volume":"377","author":"Ye","year":"2022","journal-title":"BMJ"},{"key":"2025082418351359000_13.4.e005197.4","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000002960"},{"key":"2025082418351359000_13.4.e005197.5","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002501"},{"key":"2025082418351359000_13.4.e005197.6","doi-asserted-by":"publisher","DOI":"10.2337\/dci17-0041"},{"key":"2025082418351359000_13.4.e005197.7","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1111\/dme.13705","article-title":"Language matters. 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