Primary Care Utilization After Pregnancies Complicated by Hypertension and Diabetes: An Analysis of the Medical Expenditure Panel Survey From 2016-2022

Background: Primary care after pregnancy allows for cardiovascular risk factor modification amidst rising rates of cardiometabolic complications in pregnancy. However, postpartum primary care utilization is understudied, with few national studies among the privately insured. In response to updated professional guidelines and expanded insurance access, we conducted a nationally representative, multipayer study among privately and publicly insured individuals with cardiometabolic complications to explore primary care utilization after pregnancy. Methods: Using Medical Expenditure Panel Survey (MEPS) data from 2016 to 2022, we conducted a retrospective cohort study examining primary care and other health care utilization (obstetrics/gynecology [OB/GYN], emergency room [ER], hospitalizations) after pregnancy among individuals with hypertension, pregestational diabetes, or gestational diabetes, which we collectively defined as “medically complicated pregnancy.” We used multivariable regression models to test for differences among individuals with medically complicated and uncomplicated pregnancy. Results: Among 696 postpartum individuals, 13% had a medically complicated pregnancy. In the 1 year after pregnancy, 33.3% had one or more primary care visits and 58.2% had any OB/GYN visits. Individuals with medically complicated pregnancies had a significantly higher number of ER visits by .2 visit (95% confidence interval [.1, .3]); there were no other significant differences in primary care or other health care utilization in the postpartum year. Conclusion: Primary care utilization in the year after pregnancy remains suboptimal, even among individuals with medically complicated pregnancy. These findings highlight a key missed opportunity after pregnancy for cardiovascular risk factor modification and underscore the need for interventions aimed at improving postpartum transitions to primary care.

Duke Scholars

Author Clarissa Jonas Diamantidis Medicine, General Internal Medicine