Postpartum Medicaid Extension to Address Racial Inequity in Maternal Mortality

Kumar, Natasha R.; Borders, Ann; Simon, Melissa A.

doi:10.2105/ajph.2020.306060

Cited by 16 publications

(20 citation statements)

References 3 publications

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“…Medicaid is the largest payer for maternity care in the U.S., providing coverage for pregnant and postpartum women living at 138% of the federal poverty line (FPL), although only provides coverage for mothers up to 60 days postpartum despite a considerable number of maternal deaths and complications occurring after this time [103,104]. Under the Affordable Care Act coverage expansions in 2014, states were given the option to expand Medicaid eligibility to all adults under the age of 65 up to 138% of the FPL, regardless of pregnancy status [105].…”

Section: Insurance Coverage Expansionsmentioning

confidence: 99%

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

Dagher

Linares

2022

Children

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Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). Methods: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. Results: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism across the life course. Upstream SDoH are important contributors to disparities in maternal and infant mortality. More research is needed on the effectiveness of continuous quality improvement initiatives for the maternal–infant dyad, and expanding programs such as paid maternity leave, quality, stable and affordable housing, and social safety-nets (Medicaid, CHIP, WIC), in reducing maternal and infant mortality. Finally, it is important to address research gaps in individual, interpersonal, community, and societal factors, because they affect maternal and infant mortality and related disparities. Conclusion: Key SDoH at multiple levels affect maternal and infant health. These SDoH shape and perpetuate disparities across the lifespan and are implicated in maternal and infant mortality disparities.

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Section: Insurance Coverage Expansionsmentioning

confidence: 99%

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

Dagher

Linares

2022

Children

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“…64,65 First and foremost, universal health insurance for the entire year after pregnancy is essential. 60 Comparisons between Medicaid expansion and non-expansion states suggest that extending the duration of postpartum health insurance leads to increased outpatient follow-up, especially after medically complicated pregnancies. 66 In addition, specialized postpartum transition clinics have been associated with improved postpartum transitions to primary care 67,68 and blood pressure management.…”

Section: Discussionmentioning

confidence: 99%

Primary Care–Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review

et al. 2022

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Several common adverse pregnancy outcomes can reveal subclinical or latent cardiovascular disease (CVD) risk, transiently exposed through the physiologic stress of pregnancy. The year after pregnancy may be a singular opportunity to identify and initiate treatment for CVD risk, even before the onset of traditional CVD risk factors. However, clinical guidance regarding CVD risk management after adverse pregnancy outcomes is lacking. We therefore conducted a systematic review of US clinical practice guidelines and professional society recommendations to inform primary care-based CVD risk management after adverse pregnancy outcomes. We identified 13 relevant publications. While most recommendations were based on limited or weak evidence, we identified several areas of consensus. First, individuals with an adverse pregnancy outcome associated with future CVD are likely to benefit from CVD risk assessment-accompanied by education, counseling, and support for lifestyle modification-beginning within the first postpartum year. Second, among clinicians, clear and consistent documentation about adverse pregnancy outcomes and recommended follow-up is important to coordinate care after pregnancy. In addition, patients need to be informed about their pregnancy complications and associated CVD risks, so that they can make informed health care and lifestyle decisions. Finally, in general, CVD prevention in the year after an adverse pregnancy outcome focuses on lifestyle modification, reserving pharmacotherapy for the highest-risk patients and those with traditional CVD risk factors. While postpartum lifestyle interventions show promise for reducing CVD risk after adverse pregnancy outcomes, continued research to determine the optimal content, timing, and long-term effects of such interventions is needed.

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“…Attention has also been paid to improving the quality of postpartum care via health system interventions such as the use of patient navigators [ 63 •]. Supplementing the changing definition of postpartum care, ACOG and SMFM have dedicated sustained political support to efforts to extend Medicaid coverage to 12 months postpartum; an increasing number of states, including some Southern states that did not support Medicaid expansion through the Patient Protection and Affordable Care Act, have passed legislation or applied for Centers for Medicare and Medicaid Services waivers for postpartum Medicaid extension [ 64 , 65 ]. This extended coverage will significantly improve ongoing care beyond the early postpartum period to ensure prioritization on improving long-term health.…”

Section: Paradigm Shifts In Management Of Postpartum Hypertensionmentioning

confidence: 99%

Best Practices for Managing Postpartum Hypertension

Kumar

Hirshberg

Srinivas

2022

Curr Obstet Gynecol Rep

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Purpose of Review Patients remain at risk for persistent and de novo postpartum hypertension related to pregnancy. This review aims to summarize the current definitions, clinical practices, and novel systems innovations and therapies for postpartum hypertension. Recent Findings Recent changes to the definitions of hypertension outside of pregnancy have not yet impacted definitions or management of hypertensive disorders of pregnancy (HDP), though research examining the implications of these new definitions on risks of developing HDP and the resultant sequelae is ongoing. The administration of diuretics has been shown to reduce postpartum hypertension among women with HDP. Widespread implementation of telemedicine models and remote assessment of ambulatory blood pressures has increased data available on postpartum blood pressure trajectories, which may impact clinical management. Additionally, policy changes such as postpartum Medicaid extension and an increasing emphasis on building bridges to primary care in the postpartum period may improve long-term outcomes for women with postpartum hypertension. Prediction models utilizing machine learning are an area of ongoing research to assist with risk assessment in the postpartum period. Summary The clinical management of postpartum hypertension remains focused on blood pressure control and primary care transition for cardiovascular disease risk reduction. In recent years, systemic innovations have improved access through implementation of new care delivery models. However, the implications of changing definitions of hypertension outside of pregnancy, increased data assessing blood pressure trajectories in the postpartum period, and the creation of new risk prediction models utilizing machine learning remain areas of ongoing research.

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Postpartum Medicaid Extension to Address Racial Inequity in Maternal Mortality

Cited by 16 publications

References 3 publications

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

Primary Care–Based Cardiovascular Disease Risk Management After Adverse Pregnancy Outcomes: a Narrative Review

Best Practices for Managing Postpartum Hypertension

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