Postpartum Health Care Use After Gestational Diabetes and Hypertensive Disorders of Pregnancy

Abstract

Objective: To examine postpartum health care utilization after a pregnancy complicated by gestational diabetes (GD) and hypertensive disorders of pregnancy (HDP) using nationally representative data. Materials and Methods: We examined longitudinal pooled panel data from the 1996-2007 Medical Expenditure Panel Survey with linked data from Pregnancy Detail Files on adult women (>18) with singleton pregnancies who reported an infant delivery. Multivariable weighted logistic regression analyses, including interactions, examined the associations between pregnancy complications (GD/HDP) and three postpartum health care utilization outcomes, adjusting for demographic characteristics. Results: The unweighted sample size included 304 women. Overall, 32% did not report an office visit within 12 weeks postpartum, and 15% did not report an office visit within 1 year postpartum. In addition, 15% had ≥1 emergency room (ER) visit 1 year postpartum. Women with GD/HDP compared with those with neither complication had more ER visits 1 year postpartum (unadjusted mean 4.9 vs. 2.3; p < 0.01). In multivariable analyses, GD and HDP were not independently associated with outcomes. However, education marginally modified the pregnancy complication-office visit 1 year postpartum relationship (p = 0.06). Other demographic characteristics were independently associated with each postpartum health care utilization outcome after adjustment. Conclusions: Women with GD/HDP did not differ from women with neither complication on postpartum utilization outcomes. Less educated women with GD/HDP were more likely to miss an office visit within 1 year postpartum than less educated women with neither complication. Certain subgroups of women were more likely to forego timely and appropriate postpartum care. Efforts to improve care coordination and insurance coverage access during the postpartum period are needed.

Keywords: gestational diabetes; hypertensive disorders of pregnancy; postpartum health care.