Wendy Bennet, MD, says “pregnancy is a teachable moment.” It’s when many women are highly motivated to improve lifestyle choices that produce healthier outcomes for themselves and the children they bear. Unfortunately, women don’t always come back for follow-up care once their children are born, thereby missing an important window of opportunity to learn about the preventive measures that might safeguard their health for the rest of their lives.

Bennet is an Assistant Professor of Medicine at Johns Hopkins University in Baltimore, Maryland, and lead researcher in a study of postpartum medical follow-up visits. The medical community recommends all women make and keep an appointment to see their obstetricians within six weeks after delivery (six-week postpartum visit) and to see a primary care physician within the first year but only about half do so.

Women who faced complications during pregnancy are at increased risk for chronic diseases such as high blood pressure, heart disease, and diabetes throughout their lives. The risk is especially high for women diagnosed during pregnancy with high blood pressure or gestational diabetes and for women who were diabetic before pregnancy.

The recommended follow-up visits provide the ideal opportunity to discuss preventive measures with a woman to minimize her risk of these chronic conditions later. It’s also an excellent opportunity for the obstetrician to release the patient from specialized maternity care into primary care medicine.

To determine the follow-up rate for women in Maryland, Bennet’s research team evaluated the patient records from a commercial health insurance provider and from various Medicare plans.

Three-Month Postpartum Obstetric Visit

The follow-up rate with obstetricians was only slightly higher than visits to primary care later in the year.
Of the Medicaid beneficiaries:

  • 65% who experienced pregnancy-related complications saw their obstetricians.
  • 61.5% who did not experience pregnancy-related complications saw their obstetricians.

Of those with commercial health insurance:

  • 50.8% with complicated pregnancies followed up with their obstetricians.
  • 44.6% without complications followed up with their obstetricians.

One-Year Primary Care Visit

The percentage of women seeking primary care within the first year after delivery were about the same as those seeking obstetric follow-up.

Of the Medicaid beneficiaries:

  • 56.6% who experienced complications of pregnancy saw primary-care physicians.
  • 51.7% with no pregnancy complications saw primary-care physicians.

Of those with commercial health insurance:

  • 60% experiencing complications followed up within the first year.
  • 49.6% without complications followed up within the first year.

Outside the insurance parameter, patients with these characteristics were more likely to see a primary-care physician within the first year after delivery: older, white, and those diagnosed with preeclampsia or depression.

Bennet would like to see the system for maternal follow-up visits made more attractive or convenient for mothers. Suggestions to do so include combination mother-and-baby visits, home visits, and community-based events that promote postpartum health.

Source: “Fewer Than Half of Women Attend Recommended Doctors Visits After Childbirth.” Johns Hopkins Medicine / News and Publications. The Johns Hopkins University. Feb 5, 2014. Web. Feb 18, 2014.