Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data
- 504 Downloads
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.
KEY WORDSpregnancy 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.
The study was approved by the Institutional Review Board of the Johns Hopkins University School of Medicine.
- 3.Carr DB, Newton KM, Utzschneider KM, et al. Preeclampsia and risk of developing subsequent diabetes. Hypertens Pregnancy. 2009:1-13.Google Scholar
- 4.Fraser A, Nelson SM, Macdonald-Wallis C, et al. 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. 2012;125(11):1367–1380.PubMedCentralPubMedCrossRefGoogle Scholar
- 8.Gestational diabetes mellitus. Diabetes Care. 2004;27(1):S88–S90.Google Scholar
- 9.American College of Obstetricians-Gynecologists Practice Bulletin. Clinical Management guidelines for obstetrician-gynecologists. Number 30, September 2001 (replaces technical bulletin number 200, Dec 1994). Gestational Diabetes. Obstet Gynecol. 2001;98(3):525–538.Google Scholar
- 11.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.Google Scholar
- 18.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
- 22.The Dartmouth Atlas of Healthcare. Available at: http://www.dartmouthatlas.org/tools/downloads.aspx?tab=37. Accessed October 10, 2013
- 26.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.
- 33.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.
- 34.Cheng TL, Solomon BS. Translating life course theory to clinical practice to address health disparities. Matern Child Health J. 2013.Google Scholar
- 35.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.