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Supporting Transitions to Primary care among Under-resourced, Postpartum women: The STEP-UP Trial


September 2022 – August 2025

Funding Source:

National Heart, Lung, and Blood Institute (NHLBI)

Grant Number:



Gestational Diabetes (GDM) and hypertensive disorders of pregnancy (HDP) affect up to 8% and 14% of pregnancies annually in the U.S., respectively. While these disorders often resolve post-pregnancy, a sizable body of evidence has found that women with GDM and/or HDP remain at increased, long-term risk of adverse cardiometabolic outcomes. This includes a 17-fold higher risk of type 2 diabetes (T2D) and an up to 10-fold higher risk of hypertension over the years following pregnancy. Clinical guidelines therefore recommend that patients with GDM and/or HDP transition from OB to primary care to establish a medical home for ongoing evaluation and/or disease management. Yet studies show only ~25% of high-risk postpartum women see a primary care provider within 6 months of delivery. Limited patient understanding of cardiometabolic risks, poor coordination between OB and primary care, and logistical challenges to scheduling and attending visits have been identified as barriers. Women who are Black, Hispanic, and/or low-income, as well as those with low health literacy, are less likely to receive follow-up care.


STEP-UP will promote linkage to primary care and ongoing chronic disease evaluation for postpartum women with prior GDM and/or HDP by promoting:

  • counseling and referral to primary care, during OB visits, via EHR-based clinical decision support (CDS)
  • dysglycemia testing for women with prior GDM, prompted via CDS during both OB and primary care visits
  • dissemination of understandable information on future risk and the need for ongoing evaluation generated automatically via the EHR and printed for patients with after-visit summaries (AVS)
  • motivational messaging and reminders supporting transitions of care delivered directly to patients via short message service (SMS) text messages
  • individualized outreach and support for those who need additional help arranging a primary care visit
We aim to (1) test the effectiveness of STEP-UP, compared with usual care, to improve within 6 months; ( 2) investigate the heterogeneity of STEP-UP intervention effects by patients’ race, ethnicity, and language; and (3) assess the reach, adoption, implementation, maintenance, and costs of STEP-UP components. identifier:



• Principal Investigator: Stacy Bailey, PhD MPH
• Project Manager: Guisselle Wismer, MPH