(835) Optimizing the 4th Trimester: Factors That Drive Attendance to a Comprehensive Postpartum Cardiometabolic Clinic

Gestational adverse metabolic outcomes (AMO), including hypertension (HTN) & diabetes (DM), impact maternal cardiometabolic (CM) health. The current practice of a ~6-week (wk) postpartum (PP) visit is insufficient to address all necessary long-term issues. We initiated a 12-wk Postpartum Cardiometabolic Clinic (PPMC) for patients with a gestational AMO to provide comprehensive/individualized guidance & noted that attendance increases follow-up with primary/specialty care. We therefore investigated what factors impact attendance to PPMC.


Study Design:

This retrospective cohort study included those with a gestational AMO referred to PPMC between 8/22-7/23. We compared demographic/CM factors between attendees/non-attendees of 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:

150 patients were referred to PPMC. Attendees were more likely to be referred > 2wks PP; non-attendees were more likely to be referred from L&D (Table 1). Attendees were more likely to have a PP readmission (26.9% vs. 10.5%, p< 0.05) & routine PP visit (90.3% vs. 70.2%, p< 0.01) compared to non-attendees. Those with preeclampsia (PRE) w/ severe features (SF) were more likely to attend vs. no-show PPMC (75.5% vs. 25.5%, p< 0.05) whereas those with gestational HTN or PRE w/o SF were less likely to attend (33.3% vs 66.6%, p< 0.01). After controlling for confounders (age, race, education, insurance & parity), those w/ a routine PP visit or readmission had a 1-2-fold higher likelihood of attending PPMC (ARR 1.9, 95% CI 1.1-3.3, p=0.02; ARR 1.3, 95% CI 1.0-1.8, p=0.04).


Conclusion:

Understanding factors impacting attendance to PP care is imperative. Here we demonstrate that referral timing & routine PP visit attendance significantly affect PPMC attendance. Our innovative data underscore the need to investigate factors driving these differences in PP clinic attendance as the 4^th trimester is a critical gateway in the continuum of long-term maternal health.