Disparities in Postpartum Contraceptive Counseling and Provision Among Mothers of Preterm Infants

Dude, Annie; Matulich, Melissa C.; Estevez, Samantha L.; Liu, Lilly Y.; Yee, Lynn M.

doi:10.1089/jwh.2017.6561

Cited by 15 publications

(15 citation statements)

References 30 publications

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“…Notably, decisions regarding contraception were not centered explicitly around method effectiveness to achieve adequate interpregnancy intervals as a preventive measure for subsequent preterm birth. Similar to other studies of people who gave birth prematurely, approximately one-third of participants chose less effective methods (Leaverton et al, 2016;Dude et al, 2018). These findings underscore that some individuals prioritize other features when choosing a method.…”

Section: Discussionsupporting

confidence: 81%

“…Short interpregnancy intervals increase the risk of recurrent preterm birth, and delaying conception for at least 12 months after a preterm birth can decrease the risk of recurrence (DeFranco, Stamilio, Boslaugh, Gross, & Muglia, 2007). The use of effective postpartum contraception can help to achieve optimal interpregnancy intervals (Rodriguez, Chang, & Thiel de Bocanegra, 2015); however, both receipt of postpartum contraception counseling and method use vary widely among patients with a recent preterm birth (Dude, Matulich, Estevez, Liu, & Yee, 2018). A population-based survey from 2009 to 2011, including more than 6,000 women with a recent preterm birth from nine U.S. states, found that most chose user-dependent methods, such as short-acting hormonal or barrier methods, and those who had an extremely preterm birth (27 weeks gestation) were more likely to report contraception non-use compared to women who gave birth at more than 28 weeks gestation and at term (Robbins, Farr, Zapata, D'Angelo, & Callaghan, 2015).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Future Pregnancy Considerations after Premature Birth of an Infant Requiring Intensive Care: A Qualitative Study

Chen

Kair

Schwarz

et al. 2022

Women's Health Issues

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Section: Discussionsupporting

confidence: 81%

mentioning

confidence: 99%

Future Pregnancy Considerations after Premature Birth of an Infant Requiring Intensive Care: A Qualitative Study

Chen

Kair

Schwarz

et al. 2022

Women's Health Issues

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“…Previous studies on postpartum visit content focused primarily on diabetes screening and contraceptive counseling and uptake. 14,25 However, the evidence on overall postpartum visit content is limited. Our results reporting higher levels of information at the postpartum visit among racial/ethnic minority people compared with non-Hispanic White people is similar to results reported in the Listening to Mothers III survey, which reported that non-Hispanic Black people were the most likely (compared with Hispanic or non-Hispanic White people) to say they received “enough information” on healthy eating, birth control, and depression.…”

Section: Discussionmentioning

confidence: 99%

Variation in the Content of Postpartum Visits by Maternal Race/Ethnicity, Preconception, and Pregnancy-Related Cardiovascular Disease Risk, PRAMS, 2016-2017

Stanhope

Kramer

2021

Public Health Rep

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Objectives Limited evidence suggests racial/ethnic disparities in postpartum visit attendance; however, little is known about patterns in postpartum visit content. We sought to determine whether receipt of screening and counseling varies by race/ethnicity and whether cardiovascular disease (CVD) risk (preconception or pregnancy related) predicts postpartum visit content. Methods We used data from the Pregnancy Risk Assessment Monitoring System 2016-2017 (39 sites) to calculate the prevalence of self-reported receipt of screening, services, and counseling at the postpartum visit by race/ethnicity and CVD risk (unweighted analytic sample n = 59 427). We created a score representing receipt of 5 key screenings or messages at the visit (counseling on healthy eating and exercise, cigarettes, pregnancy spacing, and birth control methods; screening for depression), which we used as a binary indicator of visit content in regression models. We fit a logistic regression model to determine the magnitude of association between CVD risk and receipt of the 5 key messages, prevention screening, or CVD-specific counseling (on healthy eating and exercise, smoking), adjusting for maternal age, race/ethnicity, and health insurance status. Results Overall, 40% of women reported receiving all CVD-specific prevention messages. Both prepregnancy and pregnancy-related CVD risk were associated with increased odds of receipt of CVD prevention messages (adjusted odds ratios [aOR] = 1.2; 95% CI, 1.1-1.3; and 1.1; 95% CI, 1.1-1.2, respectively). Race/ethnicity was a stronger predictor than CVD risk: non-Hispanic Black women were twice as likely as non-Hispanic White women to receive CVD prevention messages, regardless of CVD risk (aOR = 1.9; 95% CI, 1.7-2.0). Conclusions Health systems should consider novel strategies to improve and standardize the content of postpartum visits.

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“…There are some data that non-white women are less likely to perceive CVD as a significant personal health risk, although the gap in awareness has decreased over time. 20 Providers may be more likely to document counseling for black women who are at a greater lifetime risk of CVD morbidity and mortality. 21 Differential postpartum counseling on contraception by patient race has been documented with black women more likely to receive counseling.…”

Section: Original Researchmentioning

confidence: 99%

Postpartum counseling in women with hypertensive disorders of pregnancy

Triebwasser

Janssen

Sehdev

2021

American Journal of Obstetrics & Gynecology MFM

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BACKGROUND: Hypertensive disorders of pregnancy are associated with increased cardiovascular disease risk across the lifespan. The American College of Obstetricians and Gynecologists and the American Heart Association emphasize the postpartum period as an important opportunity to identify and intervene women at high risk of future cardiovascular disease. OBJECTIVE: This study aimed to determine the proportion of women with documented counseling on risks and transitions of care after hypertensive disorders of pregnancy at the postpartum visit. STUDY DESIGN: This was a retrospective longitudinal descriptive study of women with hypertensive disorders of pregnancy who were enrolled in a text-based blood pressure program from September 2018 to February 2019. We abstracted counseling in the discharge summary and postpartum note from the electronic medical record. The primary outcome was counseling at the postpartum visit defined as documentation of (1) follow-up with primary care or cardiology, (2) risk of cardiovascular disease, or (3) recommendation for aspirin in a future pregnancy. We assessed demographic and clinical factors that may influence counseling through multivariable logistic regression. We also compared the proportion of women counseled on hypertensive disorders of pregnancy vs contraception and glucose tolerance tests at the postpartum visit.RESULTS: Of 320 eligible women, most women had gestational hypertension or preeclampsia without severe features (64%). Postpartum visits were scheduled in our hospital system for 284 women, of whom 253 attended (89%). Documented counseling occurred for 62 women (25%). Counseling on follow-up with primary care or cardiology, cardiovascular disease risk, and aspirin in future pregnancies was documented for 51 (20%), 15 (6%), and 1 (0.4%), respectively. Only 1 woman had documented counseling on all 3 components. In multivariable analysis, black race remained an independent factor that increased the likelihood of counseling on hypertensive disorders of pregnancy (adjusted odds ratio, 2.77; 95% confidence interval, 1.32e5.83). Women were significantly less likely to be counseled on hypertensive disorders of pregnancy than on contraceptives (99%, P<.001) or glucose tolerance testing after gestational diabetes mellitus (79%, P<.001). CONCLUSION: Postpartum counseling on hypertensive disorders of pregnancy merits urgent improvement efforts among obstetrical care providers.

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Disparities in Postpartum Contraceptive Counseling and Provision Among Mothers of Preterm Infants

Cited by 15 publications

References 30 publications

Future Pregnancy Considerations after Premature Birth of an Infant Requiring Intensive Care: A Qualitative Study

Future Pregnancy Considerations after Premature Birth of an Infant Requiring Intensive Care: A Qualitative Study

Variation in the Content of Postpartum Visits by Maternal Race/Ethnicity, Preconception, and Pregnancy-Related Cardiovascular Disease Risk, PRAMS, 2016-2017

Postpartum counseling in women with hypertensive disorders of pregnancy

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