Patterns of Postpartum Ambulatory Care Follow-up Care Among Women With Hypertensive Disorders of Pregnancy

Jennifer Lewey, Lisa D Levine, Lin Yang, Jourdan E Triebwasser, Peter W Groeneveld, Jennifer Lewey, Lisa D Levine, Lin Yang, Jourdan E Triebwasser, Peter W Groeneveld

Abstract

Background Preeclampsia and gestational hypertension are hypertensive disorders of pregnancy (HDP) that identify an increased risk of developing chronic hypertension and cardiovascular disease later in life. Postpartum follow-up may facilitate early screening and treatment of cardiovascular risk factors. Our objective is to describe patterns of postpartum visits with primary care and women's health providers (eg, family medicine and obstetrics) among women with and without HDP in a nationally representative sample of commercially insured women. Methods and Results We conducted a retrospective cohort study using insurance claims from a US health insurance database to describe patterns in office visits in the 6 months after delivery. We identified 566 059 women with completed pregnancies between 2005 and 2014. At 6 months, 13% of women with normotensive pregnancies, 18% with HDP, and 23% with chronic hypertension had primary care visits (P<0.0001 for comparing HDP and chronic hypertension groups with control participants). Only 58% of women with HDP had 6-month follow-up with any continuity provider compared with 47% of women without hypertension (P<0.0001). In multivariable analysis, women with severe preeclampsia were 16% more likely to have postpartum continuity follow-up (adjusted odds ratio, 1.16; 95% CI, 1.2-1.21). Factors associated with a lower likelihood of any follow-up included age ≥30 years, Black race, Hispanic ethnicity, and having multiple gestations. Conclusions Rates of continuity care follow-up after a pregnancy complicated by hypertension were low. This represents a substantial missed opportunity to provide cardiovascular risk screening and management to women at increased risk of future cardiovascular disease.

Keywords: hypertension; preeclampsia; primary prevention; women's health.

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
CONSORT diagram of patients included in the analysis.
Figure 2. Postpartum ambulatory care follow‐up within…
Figure 2. Postpartum ambulatory care follow‐up within 6 months after delivery according to provider type.

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