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

Abstract

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.

Association of Health Insurance, Geography, and Race and Ethnicity With Disparities in Receipt of Recommended Postpartum Care in the US

“…To our knowledge, no studies have examined rural vs urban residence as a variable. Previous studies that have evaluated the content of postpartum visits have focused primarily on depression screening or contraceptive counseling . A 2021 study showed that non-Hispanic Black and Hispanic patients received more postpartum screenings than non-Hispanic White patients, as did publicly-insured patients, findings that are consistent with our own.…”

“…Disparities in Receipt of Recommended Postpartum Care in the US -2.2 (-2.9 to -1.6) b -3.9 (-4.9 to -2.9) b -2.0 (-3.5 to -0.5) c -0.9 (-1.8 to 0) 1.4 (-1.2 to 4.0) -0.8 (-1.5 to -0. received more postpartum screenings than non-Hispanic White patients, as did publicly-insured patients, 36 findings that are consistent with our own. However, that study did not discuss the role of geography or declining access to care in rural communities, 11 and did not explore possible associations with intersecting identities.…”

“…Previous studies that have evaluated the content of postpartum visits have focused primarily on depression screening or contraceptive counseling . A 2021 study showed that non-Hispanic Black and Hispanic patients received more postpartum screenings than non-Hispanic White patients, as did publicly-insured patients, findings that are consistent with our own. However, that study did not discuss the role of geography or declining access to care in rural communities, and did not explore possible associations with intersecting identities.…”

“…Previous studies that have evaluated the content of postpartum visits have focused primarily on depression screening or contraceptive counseling. [32][33][34][35][36][37] A 2021 study showed that non-Hispanic Black and Hispanic patients…”

Trends in Cardiovascular Health Counseling Among Postpartum Individuals

“…The postpartum period is an opportune time when there is contact with the health care system, and counseling for CVH could potentially improve CVD-related outcomes during subsequent pregnancies and throughout the life course because individuals with poor CVH are more likely to experience subsequent APOs and CVD later in life . However, in 2016-2017, only 40% of individuals in the US who attended a 4- to 6-week postpartum visit reported receiving CVD prevention messages, and receipt of these messages was only slightly higher among those with CVD risk factors or APOs . Since then, the American Heart Association has released several consensus statements describing opportunities to improve CVH during the peripartum period …”