172516 Predictors of the Postpartum Visit: Do High-Risk Women get More or Less Care?"

Wednesday, October 29, 2008

Kelli Jarrett , Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA
Briane Accius , Department of Maternal and Child Health, Boston University School of Public Health, Boston, MA
Milton Kotelchuck, MPH, PhD, MA , Harvard University, MA
Background: Despite a recent focus on developing internatal care, the six-week postpartum visit remains the only part of interconception care currently implemented universally. There is evidence that racial/ethnic disparities exist in who utilizes postpartum care, but this topic has not been extensively studied. In this study, we examine whether women with high risk conditions (any diabetes, hypertension, and preterm birth) have higher levels of postpartum care, and whether this varies by race/ethnicity.

Methods: Study data comes from 14 states in the 2004 and 2005 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire that asked women if they received a postpartum visit. Analytically, we compare women with each high risk condition to all other women, then stratify by race/ethnicity, adjusting for the PRAMS complex sampling frame.

Results: Overall, the postpartum visit rate for 2004-2005 across the 14 states was 89.3%, well short of the universal recommendation. Postpartum visit rates for women with hypertension were only slightly higher (89.9%), while rates for women with diabetes and early prematurity were lower (88.1% and 85.9%, respectively). Race- and ethnicity-specific analyses showed similar patterns, but black and Hispanic women had lower postpartum visit rates than white women across all high risk conditions.

Conclusion: The postpartum visit is an opportunity to bring women into the healthcare system for internatal care. Disparities in rates of postpartum visits could lead to further disparities in women's health and birth outcomes. The results indicate the need to address public health practices to ensure equitable postnatal care for all high risk women.

Learning Objectives:
1. To evaluate the utility of the PRAMS dataset to assess postpartum visit rates. 2. To understand if high risk medical factors noted at the end of a woman's pregnancy influence utilization of postpartum visits. 3. To understand if race/ethnicity influences postpartum visit rates for high risk women.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I worked on this project as part of an MPH student fellowship and took part in the design and analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.