Disparities in Postpartum Care After a Hypertensive Disorder of Pregnancy in the United States.

Abstract

Background: The postpartum period is a critical time for blood pressure monitoring and cardiovascular risk factor modification in individuals with hypertensive disorders of pregnancy (HDP), who are at increased risk for cardiovascular disease.

Methods: We analyzed data from the Pregnancy Risk Assessment Monitoring System, a nationally representative US population-based survey of postpartum women with live births from 2016 to 2022. Among individuals with HDP, we evaluated the association between race, ethnicity, and other socioeconomic factors and (1) postpartum visit attendance and (2) postpartum counseling/screening.

Results: Among 42 858 participants with HDP (weighted n=2 011 284), 90% reported attending a postpartum visit. Adjusting for other factors, Hispanic individuals (odds ratio, 0.75 [95% CI, 0.60-0.94]), non-Hispanic Black individuals (odds ratio, 0.75 [95% CI, 0.62-0.91]), and individuals of other or multiple races (odds ratio, 0.57 [95% CI, 0.44-0.74]) were less likely to attend a postpartum visit, compared with non-Hispanic White individuals. Individuals with lower income, lower educational attainment, and those with Medicaid or no insurance were significantly less likely to report attending a postpartum visit. Among those who reported attending a postpartum visit, only 56.3% reported receiving postpartum counseling on healthy lifestyle, 60.9% reported receiving screening for cigarette smoking, and 23.7% reported receiving testing for diabetes.

Conclusions: Most individuals with HDP reported attending a postpartum visit, but there were significant disparities in postpartum visit attendance by race/ethnicity, health insurance, and socioeconomic status. In addition, many participants reported not receiving postpartum counseling or screening for cardiovascular risk factors. This represents a missed opportunity to equitably improve the long-term cardiovascular health of individuals with HDP.