Postpartum Primary Care in the United States: A Scoping Review of the Evidence Base and Opportunities.

Abstract

Background: The United States is experiencing a maternal health crisis that continues to worsen in the face of racial/ethnic disparities, rising chronic disease burden among birthing patients, and policy barriers to health care access. Longitudinal postpartum primary care is critical to mitigating these trends, but current rates of use are low, and evidence-based interventions are limited. This scoping review aims to understand the current literature and components of the Chronic Care Model (CCM) used in postpartum primary care and its impact on maternal health outcomes. Methods: We identified 74 studies published between 2000 and 2023 through comprehensive searches of four databases. Extracted data was synthesized for their impact on maternal health, including equity considerations and the primary CCM element. Results: The studies were collated based on their primary maternal health priority (general health n = 13, depression and anxiety n = 34, diabetes n = 3, hypertension n = 5, adolescent parents n = 6, and substance use disorder n = 13). The most common CCM elements were Delivery System Design and Self-Management Support. The least common CCM element was Clinical Information Systems, with electronic health record challenges noted as a barrier. We identified successful interventions that increased depression screening, postpartum hypertension follow-up via telehealth, and integrated contraceptive education within shared parent-child medical homes for adolescent parents. Interventions were largely feasible and acceptable for both patients and clinicians. Conclusions: This review highlights several potential strategies to improve and scale longitudinal postpartum primary care. Further work is needed to ensure equitable delivery, improved connection with community resources, and to expand informatics in postpartum care.