Utilization of primary and obstetric care after medically complicated pregnancies: an analysis of medical claims data.
BACKGROUND
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.


OBJECTIVE
To determine predictors of post-delivery primary and obstetric care utilization in women with and without medical complications.


METHODS
Five-year retrospective cohort study using commercial and Medicaid insurance claims in Maryland.


METHODS
7,741 women with a complicated pregnancy (GDM, hypertensive disorders and pregestational diabetes mellitus [DM]) and 23,599 women with a comparison pregnancy.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Division of General Internal Medicine, The Johns Hopkins University School of Medicine, 2024 E. Monument St, Suite 2-616, Baltimore, MD, 21205, USA, Wendy.bennett@jhmi.edu.
Wendy L
WL
Bennett
Hsien-Yen
HY
Chang
David M
DM
Levine
Lin
L
Wang
Donna
D
Neale
Erika F
EF
Werner
Jeanne M
JM
Clark
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007345:Insurance Claim Review / Q000639:trends; D007348:Insurance, Health / Q000706:statistics & numerical data* / Q000639:trends; D008396:Maryland / Q000453:epidemiology; D008484:Medicaid / Q000706:statistics & numerical data* / Q000639:trends; D009774:Obstetrics / Q000639:trends; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D011320:Primary Health Care / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult