Bridging the Postpartum Cliff-First Year Outcomes of a Postpartum Transition to Primary Care Clinic.

Abstract

Background: Half of maternal deaths occur after 42 days postpartum, a time when women are already out of obstetrical care. The American College of Obstetricians and Gynecologists recommends postpartum transition to primary care within 12 weeks of delivery. The majority of women do not transition to primary care, even those with chronic conditions like hypertension and diabetes. Those who do may experience the "postpartum cliff," a drop-off in communication between obstetrician-gynecologist (OB/GYN) and primary care provider (PCP).

Objective: The purpose of this study is to assess attendance rates at primary care appointments among high-risk postpartum patients who were referred through an enhanced postpartum referral system and to evaluate follow-up care in the early postpartum period.

Methods: A dedicated "Healthy Moms Clinic" (HMC) and referral protocol were established using patient navigators between maternal fetal medicine (MFM) and primary care in January 2023. A retrospective chart review was conducted in November 2024 of women who were referred from MFM to primary care. The primary outcome variable was attendance rate at the HMC. Secondary outcomes included preventive screenings, contraception use, and management of chronic conditions such as hypertension and diabetes.

Results: Of 106 referrals between January 2023 and July 2024, 93.4% attended their 6-week postpartum OB/GYN visit. Half (53.8%) attended the initial PCP visit, and 30.2% of the missed appointments were rescheduled. If the visit was rescheduled, half of those patients attended their rescheduled appointment with an overall show rate of 70.8%. There was no difference in show rates by race/ethnicity (patients identified primarily as Black or Hispanic) nor by insurance type.

Conclusion: Coordination between obstetrics and primary care through dedicated transition clinics allows interdisciplinary collaboration, providing a solution for missed care postpartum. More time is needed to assess long-term outcomes such as hypertension control, diabetes control, and weight loss.