Journal of General Internal Medicine

, Volume 29, Issue 4, pp 636–645 | Cite as

Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data

  • Wendy L. Bennett
  • Hsien-Yen Chang
  • David M. Levine
  • Lin Wang
  • Donna Neale
  • Erika F. Werner
  • Jeanne M. Clark



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.


pregnancy utilization of care primary care gestational diabetes mellitus hypertension 




Dr. Wendy Bennett is supported by a career development award from the National Heart, Lung, and Blood Institute, 5K23HL098476– 02.

Conflict of Interest

The authors declare that they do not have any conflicts of interest.

Ethical Approval

The study was approved by the Institutional Review Board of the Johns Hopkins University School of Medicine.

Supplementary material

11606_2013_2744_MOESM1_ESM.pdf (96 kb)
ESM 1 (PDF 96 kb)


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Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Wendy L. Bennett
    • 1
    • 2
    • 3
  • Hsien-Yen Chang
    • 3
  • David M. Levine
    • 1
    • 3
  • Lin Wang
    • 4
  • Donna Neale
    • 5
  • Erika F. Werner
    • 6
  • Jeanne M. Clark
    • 1
    • 2
    • 3
  1. 1.Division of General Internal MedicineThe Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreUSA
  3. 3.The Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Johns Hopkins HealthCare, LLCGlen BurnieUSA
  5. 5.Department of Gynecology and ObstetricsThe Johns Hopkins University School of MedicineBaltimoreUSA
  6. 6.Department of Obstetrics and GynecologyAlpert Medical School of Brown UniversityProvidenceUSA

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