Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data
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Because pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy, are risk factors for diabetes and cardiovascular disease, post-delivery follow-up is recommended.
To determine predictors of post-delivery primary and obstetric care utilization in women with and without medical complications.
Five-year retrospective cohort study using commercial and Medicaid insurance claims in Maryland.
7,741 women with a complicated pregnancy (GDM, hypertensive disorders and pregestational diabetes mellitus [DM]) and 23,599 women with a comparison pregnancy.
We compared primary and postpartum obstetric care utilization rates in the 12 months after delivery between the complicated and comparison pregnancy groups. We conducted multivariate logistic regression to assess the association between pregnancy complications, sociodemographic predictor variables and utilization of care, stratified by insurance type.
Women with a complicated pregnancy were older at delivery (p < 0.001), with higher rates of cesarean delivery (p < 0.0001) and preterm labor or delivery (p < 0.0001). Among women with Medicaid, 56.6 % in the complicated group and 51.7 % in the comparison group attended a primary care visit. Statistically significant predictors of receiving a primary care visit included non-Black race, older age, preeclampsia or DM, and depression. Among women with commercial health insurance, 60.0 % in the complicated group and 49.5 % in the comparison group attended a primary care visit. Pregnancy complication did not predict a primary care visit among women with commercial insurance.
Women with pregnancy complications were more likely to attend primary care visits post-delivery compared to the comparison group, but overall visit rates were low. Although Medicaid expansion has potential to increase coverage, innovative models for preventive health services after delivery are needed to target women at higher risk for chronic disease development.
- Bellamy, L, Casas, JP, Hingorani, AD, Williams, D (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 373: pp. 1773-1779 CrossRef
- Bellamy, L, Casas, JP, Hingorani, AD, Williams, DJ (2007) Pre-eclampsia and risk of cardiovascular disease and cancer in later life: Systematic review and meta-analysis. BMJ 335: pp. 974 CrossRef
- Carr DB, Newton KM, Utzschneider KM, et al. Preeclampsia and risk of developing subsequent diabetes. Hypertens Pregnancy. 2009:1-13.
- Fraser, A, Nelson, SM, Macdonald-Wallis, C (2012) Associations of pregnancy complications with calculated cardiovascular disease risk and cardiovascular risk factors in middle age: the avon longitudinal study of parents and children. Circulation 125: pp. 1367-1380 CrossRef
- Cheung, NW, Byth, K (2003) Population health significance of gestational diabetes. Diabetes Care 26: pp. 2005-2009 CrossRef
- Sattar, N, Greer, IA (2002) Pregnancy complications and maternal cardiovascular risk: opportunities for intervention and screening?. BMJ 325: pp. 157-160 CrossRef
- Rich-Edwards, JW, McElrath, TF, Karumanchi, SA, Seely, EW (2010) Breathing life into the lifecourse approach: pregnancy history and cardiovascular disease in women. Hypertension 56: pp. 331-334 CrossRef
- Gestational diabetes mellitus. Diabetes Care. 2004;27(1):S88–S90.
- Clinical Management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces technical bulletin number 200, Dec 1994). Gestational Diabetes. Obstet Gynecol 98: pp. 525-538
- Metzger, BE, Buchanan, TA, Coustan, DR (2007) Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes care 30: pp. 251-260 CrossRef
- Report of the national high blood pressure education program working group on high blood pressure in pregnancy. Am J Obstet Gynecol. 2000;183(1):S1–S22.
- Smirnakis, KV, Chasan-Taber, L, Wolf, M, Markenson, G, Ecker, JL, Thadhani, R (2005) Postpartum diabetes screening in women with a history of gestational diabetes. Obstet Gynecol 106: pp. 1297-1303 CrossRef
- Kim, C, Tabaei, BP, Burke, R (2006) Missed opportunities for type 2 diabetes mellitus screening among women with a history of gestational diabetes mellitus. Am J Public Health 96: pp. 1643-1648 CrossRef
- Russell, MA, Phipps, MG, Olson, CL, Welch, HG, Carpenter, MW (2006) Rates of postpartum glucose testing after gestational diabetes mellitus. Obstet Gynecol 108: pp. 1456-1462 CrossRef
- Ferrara, A, Ehrlich, SF (2011) Strategies for diabetes prevention before and after pregnancy in women with GDM. Curr Diabetes Rev 7: pp. 75-83 CrossRef
- Ferrara, A, Hedderson, MM, Ching, J, Kim, C, Peng, T, Crites, YM (2012) Referral to telephonic nurse management improves outcomes in women with gestational diabetes. Am J Obstet Gynecol 206: pp. 491.e1-491.e5 CrossRef
- Hunt, KJ, Conway, DL (2008) Who returns for postpartum glucose screening following gestational diabetes mellitus?. Am J Obstet Gynecol 198: pp. 404.e1-404.e6 CrossRef
- National Committee for Quality Assurance (NCQA)0.1994-2009 Prenatal and postpartum care (PPC) definitions. Available at: http://www.ncqa.org/portals/0/Prenatal%20Postpartum%20Care.pdf. Accessed October 10, 2013
- Bennett, WL, Gilson, MM, Jamshidi, R (2010) Impact of bariatric surgery on hypertensive disorders in pregnancy: retrospective analysis of insurance claims data. BMJ 340: pp. c1662 CrossRef
- Burke, AE, Bennett, WL, Jamshidi, RM (2010) Reduced incidence of gestational diabetes with bariatric surgery. J Am Coll Surg 211: pp. 169-175 CrossRef
- Diagnosis and classification of diabetes mellitus. Diabetes Care 36: pp. S67-S74 CrossRef
- The Dartmouth Atlas of Healthcare. Available at: http://www.dartmouthatlas.org/tools/downloads.aspx?tab=37. Accessed October 10, 2013
- Bennett, WL, Ennen, CS, Carrese, JA (2011) Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: a qualitative study. J Womens Health (Larchmt). 20: pp. 239-245 CrossRef
- Vikse, BE, Irgens, LM, Leivestad, T, Skjaerven, R, Iversen, BM (2008) Preeclampsia and the risk of end-stage renal disease. N Engl J Med 359: pp. 800-809 CrossRef
- Clark, HD, Graham, ID, Karovitch, A, Keely, EJ (2009) Do postal reminders increase postpartum screening of diabetes mellitus in women with gestational diabetes mellitus? A randomized controlled trial. Am J Obstet Gynecol 200: pp. 634.e1-634.e7 CrossRef
- National Committee for Quality Assurance (NCQA). 2012 NCQA summary table of measures, product lines and changes. Available at: http://www.ncqa.org/LinkClick.aspx?fileticket=O-31v4G27sU%3d&tabid=1415. Accessed October 10, 2013.
- Johnson, K, Posner, SF, Biermann, J (2006) Recommendations to improve preconception health and health care--united states. A report of the CDC/ATSDR preconception care work group and the select panel on preconception care. MMWR Recomm Rep 55: pp. 1-23
- Lawrence, JM, Contreras, R, Chen, W, Sacks, DA (2008) Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005. Diabetes Care 31: pp. 899-904 CrossRef
- Wallis, AB, Saftlas, AF, Hsia, J, Atrash, HK (2008) Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, united states, 1987-2004. Am J Hypertens 21: pp. 521-526 CrossRef
- Kim, SY, Saraiva, C, Curtis, M, Wilson, HG, Troyan, J, Sharma, AJ (2013) Fraction of gestational diabetes mellitus attributable to overweight and obesity by race/ethnicity, california, 2007-2009. Am J Public Health 103: pp. e65-e72 CrossRef
- Goldenberg, RL, Culhane, JF, Iams, JD, Romero, R (2008) Epidemiology and causes of preterm birth. Lancet 371: pp. 75-84 CrossRef
- Ruser, CB, Sanders, L, Brescia, GR (2005) Identification and management of overweight and obesity by internal medicine residents. J Gen Intern Med 20: pp. 1139-1141 CrossRef
- U.S. Department of Health and Human Services Health Resources and Services Administration. Women’s Preventive Services: Required Health Plan Coverage Guidelines. Available at: http://www.hrsa.gov/womensguidelines/. Accessed October 10, 2013.
- Cheng TL, Solomon BS. Translating life course theory to clinical practice to address health disparities. Matern Child Health J. 2013.
- U.S. Department of Health and Human Services. "HHS announces expansion of Maternal, Infant, and Early Childhood Home Visiting". Available at: http://www.hhs.gov/news/press/2013pres/09/20130906a.html. Accessed October 10, 2013.
- Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data
Journal of General Internal Medicine
Volume 29, Issue 4 , pp 636-645
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- utilization of care
- primary care
- gestational diabetes mellitus
- Industry Sectors
- Author Affiliations
- 1. Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD, 21205, USA
- 2. Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University, Baltimore, MD, USA
- 3. The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 4. Johns Hopkins HealthCare, LLC, Glen Burnie, MD, USA
- 5. Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 6. Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA