Improving Postpartum and Long-Term Health After an Adverse Pregnancy Outcome: Examining Interventions From a Health Equity Perspective

Abstract

Gestational diabetes mellitus and hypertensive disorders in pregnancy are adverse pregnancy outcomes (APOs) that affect 15% of pregnancies in the United States. These APOs have long-term health implications, with greater risks of future cardiovascular and chronic disease later in life. In this manuscript, we review the importance of timely postpartum follow-up and transition to primary care after APOs for future disease prevention. We also discuss interventions to improve postpartum follow-up and long-term health after an APO. In recognizing racial and ethnic disparities in APOs and chronic disease, we review important considerations of these interventions through a health equity lens.

Defining Goals and Investing in Data to Improve Postpartum Health and Health Equity

“…2 Although interventions to improve maternal health and reduce disparities have historically focused on pregnancy and childbirth, recent data show that the majority of pregnancy-related deaths occur in the year after birth, and more than 3 in 5 deaths are preventable. 3…”

“…New models for postpartum health care delivery are being tested leveraging technology (eg, mobile health applications for remote patient monitoring, texts, or electronic health record reminders for screening and follow-up) and using health-system based models (eg, medical home, patient navigation). 3 Policy makers are also actively intervening. Half of states have adopted a new federal option to extend pregnancy Medicaid coverage from 60 days to 1 year post partum, and others are experimenting with initiatives such as expanding coverage for doulas and value-based payment for postpartum care.…”

“…For as long as maternal mortality has been measured, racial disparities have been stark and persistent: non-Hispanic Black women and birthing people are 3 to 4 times more likely than non-Hispanic White women to die from pregnancy-related causes . Although interventions to improve maternal health and reduce disparities have historically focused on pregnancy and childbirth, recent data show that the majority of pregnancy-related deaths occur in the year after birth, and more than 3 in 5 deaths are preventable …”

“…The reconceptualization of the postpartum year as a period of high maternal health risk is driving rapid innovations across the health system. New models for postpartum health care delivery are being tested leveraging technology (eg, mobile health applications for remote patient monitoring, texts, or electronic health record reminders for screening and follow-up) and using health-system based models (eg, medical home, patient navigation) . Policy makers are also actively intervening.…”

Foreword: Racial Disparities in OB/GYN

“…Focusing on health inequities racial and other minoritized persons experience in the postpartum period, the commentary by McAllister et al 6 delves into the role played by inequitable postpartum access to contraception and contraceptive education in perpetuating health disparities related to unintended pregnancy, and the authors outline evidence-based approaches, such as shared decision-making in postpartum contraceptive counseling, to achieve equity in this space. Also applying a health equity lens, Julia DiTosto et al 7 review the importance of timely postpartum followup and transition to primary care after adverse pregnancy outcomes (APOs), such as gestational diabetes mellitus and hypertensive disorders, for future disease prevention; they also discuss interventions to improve postpartum follow-up and long-term health after an APO.…”