Abstract
Despite recommendations for ongoing care after pregnancy, many individuals do not see a primary care clinician within the first postpartum year, missing a critical window to engage reproductive-age individuals in primary care. We administered an anonymous, cross-sectional, trilingual survey at a large urban safety-net hospital to assess postpartum individuals’ preferences, health concerns, and anticipated barriers to primary care during the year after pregnancy. While 90% of respondents preferred a visit within one year, most individuals – including those with complicated pregnancies – did not recall a primary care recommendation from their pregnancy care team. Respondents reported a variety of primary care-amenable health concerns, and many social and logistical barriers to care. Preference for virtual care increased if self-monitoring tools were hypothetically available, indicating virtual visits may improve primary care access.
Significance
The postpartum year is a time of increased health risks, when individuals – especially those with recent pregnancy complications – are likely to benefit from ongoing care. In minoritized and structurally marginalized communities, low rates of postpartum follow-up compound high rates of pregnancy complications, perpetuating health inequities.
AbstractSection What this Study Adds?In a racially, ethnically, and linguistically diverse and predominantly low-income sample, most postpartum individuals were unaware of recommendations to connect with primary care in the year after pregnancy, and most anticipated logistical and financial barriers to care. Increased care transition counseling, and logistical and financial support, are needed to help postpartum individuals access ongoing care.
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Data Availability
Surveys are included as supplemental material. De-identified data can be made available upon reasonable request to the corresponding author.
Code Availability
Code can be made available upon reasonable request to the corresponding author.
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Acknowledgements
The authors gratefully acknowledge the contributions of the survey participants. The authors also gratefully acknowledge funding from the Boston University Chobanian and Avedisian School of Medicine including its Department of Medicine Career Investment Award (MEMH), the American Heart Association (MEMH and CDY), the Boston University Clinical and Translational Science Institute through a grant from the NIH 1UL1TR001430 (TAB), the NIH 1R01HL158864 (CDY), and the Department of Health and Human Services, Maternal and Child Health Bureau, MCPH Leadership Education Program (LM).
Funding
Mara E. Murray Horwitz was supported by the Boston University Chobanian and Avedisian School of Medicine; the Boston University Chobanian and Avedisian School of Medicine Department of Medicine Career Investment Award; and the American Heart Association Career Development Award, 937987. Tracy A. Battaglia was supported by Boston University Clinical and Translational Science Institute through a grant from the NIH National Center for Advancing Translational Sciences 1UL1TR001430. Christina D. Yarrington was supported by a grant from the NIH National Heart Lung and Blood Institute 1R01HL158864. Mara E. Murray Horwitz and Christina D. Yarrington were additionally supported by a grant from the American Heart Association 979464. Lois McCloskey was supported in part by Department of Health and Human Services, Maternal and Child Health Bureau, MCPH Leadership Education Program, T7600017.
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MEMH: Conceptualization, Methodology, Investigation, Formal analysis, Writing – Original draft and Review & Editing, Visualization, Project administration, Funding acquisition; GSB: Investigation, Resources, Writing – Review & Editing, Visualization, Project administration; JAS: Investigation, Writing – Original draft, Review & Editing; TAB: Conceptualization, Writing – Review & Editing, Supervision; CDY: Conceptualization, Writing – Review & Editing, Supervision; LM: Conceptualization, Methodology, Writing – Review & Editing, Supervision.
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Murray Horwitz, M.E., Brédy, G.S., Schemm, J. et al. Primary Care After Pregnancy Survey: Patient Preferences, Health Concerns, and Anticipated Barriers. Matern Child Health J (2024). https://doi.org/10.1007/s10995-024-03958-8
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DOI: https://doi.org/10.1007/s10995-024-03958-8