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Q&A

Healthcare Policy/Economics

Poster Session 4

(1113) The 4th Trimester and Beyond: Optimizing Maternal Health Through a Novel Postpartum Clinic Service Line

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:

Adverse metabolic outcomes (AMO) during pregnancy increase future risks of chronic metabolic diseases, including heart disease, diabetes (DM) & hypertension (HTN). The postpartum (PP) period is when transitions to primary/specialty care services are imperative & often lacking. As such, we established a Postpartum Cardiometabolic Clinic (PPMC) for patients at 12 weeks PP with a gestational AMO to bridge gaps in care transitions. We investigated if PPMC attendance improves follow-up with primary/specialty providers.


Study Design:

This retrospective cohort study included patients referred to PPMC between 8/22-7/23 for diagnoses of chronic HTN/hypertensive disorders of pregnancy or pre-gestational/gestational DM. We compared follow-up with primary/specialty care services among those who attended vs. did not attend PPMC. Continuous variables were compared using Wilcoxon Rank Sum Tests. Categorical variables were compared using Chi-Square/Fisher’s exact tests. Log binomial regressions calculating adjusted risk ratios (ARR) were performed.


Results:

Of N=150 referrals, 62% (n=93) attended PPMC (Table 1). Persons who attended PPMC vs. those who did not were more likely to have follow-up within 6 months PP with any provider (73.1% vs. 36.8%, p< 0.001), Primary Care (40.9% vs. 22.8%, p< 0.05), or Cardiology (51.6% vs. 17.5%, p< 0.001), & have lipids/triglycerides (29.0% vs. 7.0%, p< 0.01) & HgbA1c (28.0 vs. 7.0%, p< 0.01) assessed. After controlling for confounders (age, race, parity, education & insurance), those attending PPMC had a 2-fold higher likelihood of follow-up with any provider (ARR 1.9, 95% CI 1.3-2.6, p< 0.01) or Cardiology (ARR 1.8, 95% CI 1.4-2.4, p< 0.001). There was no difference in follow-up with Endocrinology or 2-hour Glucose Tolerance Test completion between groups (Table 1).


Conclusion:

We innovatively demonstrated that a PPMC service significantly improved PP follow-up with primary/specialty care. With rates of gestational AMOs increasing & impacting long-term maternal metabolic health, our data support the need for serious considerations to change current 4th trimester standards-of-care.