Utilization of Primary and Obstetric Care After Medically Complicated Pregnancies: An Analysis of Medical Claims Data
Open accessAbstract
Background Because pregnancy complications, including gestational diabetes mellitus (GDM) and hypertensive disorders in pregnancy, are risk factors for diabetes and cardiovascular disease, post-delivery follow-up is recommended.Objective To determine predictors of post-delivery primary and obstetric care utilization in women with and without medical complications.Research design Five-year retrospective cohort study using commercial and Medicaid insurance claims in Maryland.Subjects 7,741 women with a complicated pregnancy (GDM, hypertensive disorders and pregestational diabetes mellitus [DM]) and 23,599 women with a comparison pregnancy.Measures We compared primary and postpartum obstetric care utilization rates in the 12 months after delivery between the complicated and comparison pregnancy groups. We conducted multivariate logistic regression to assess the association between pregnancy complications, sociodemographic predictor variables and utilization of care, stratified by insurance type.Results Women with a complicated pregnancy were older at delivery (p < 0.001), with higher rates of cesarean delivery (p < 0.0001) and preterm labor or delivery (p < 0.0001). Among women with Medicaid, 56.6% in the complicated group and 51.7% in the comparison group attended a primary care visit. Statistically significant predictors of receiving a primary care visit included non-Black race, older age, preeclampsia or DM, and depression. Among women with commercial health insurance, 60.0% in the complicated group and 49.5% in the comparison group attended a primary care visit. Pregnancy complication did not predict a primary care visit among women with commercial insurance.Conclusions Women with pregnancy complications were more likely to attend primary care visits post-delivery compared to the comparison group, but overall visit rates were low. Although Medicaid expansion has potential to increase coverage, innovative models for preventive health services after delivery are needed to target women at higher risk for chronic disease development.
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Attendance is lower among marginalized populations who may have limited resources.
“Attendance is lower among marginalized populations who may have limited resources [64, 65]; these populations are also at increased risk for perinatal mental health conditions [9, 66].”
From Factors associated with postpartum depression symptoms following antepartum hospitalization (2026) · cites this paper as [64]
The ‘Utilization of Postpartum Obstetric Care’ section reports lower odds of attendance for Black women than for White or Hispanic women within the Medicaid group; the primary-care analysis shows a similar pattern. This supports an attendance disparity, but the study does not establish that marginalized populations generally have lower attendance or that limited resources explain the disparity. (LLM, conf=0.84)
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- Authors
- Bennett, W. L., Chang, H.-Y., Levine, D. M., Wang, L., Neale, D., Werner, E. F., & Clark, J. M.
- Affiliations
- Johns Hopkins University (US)
- Brown University (US)
- Corresponding author
- Bennett, Wendy L.
- Venue
- Journal of General Internal Medicine
- Published
- 2014-01-29
- Volume
- 29
- Issue
- 4
- Pages
- 636-645
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC3965743
- OpenAlex
- W2015833610
- Cited by
- 214
- References
- 37
- Citations by year
- 2026: 25 · 2025: 22 · 2024: 25 · 2023: 19 · 2022: 21 · 2021: 22 · 2020: 20 · 2019: 20 · 2018: 13 · 2017: 9 · 2016: 7 · 2015: 9 · 2014: 1
- FWCI
- 9.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL098476)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- complicated pregnancy, postpartum care utilization, primary care visits, obstetric care, gestational diabetes mellitus, hypertensive disorders of pregnancy, preeclampsia, pregestational diabetes, Medicaid, commercial health insurance, cesarean section, preterm labor, postpartum depression, racial disparities, Medicaid expansion, preventive medicine
- MeSH terms
- Adolescent, Adult, Female, Follow-Up Studies, Humans, Insurance Claim Review, Insurance, Health, Maryland, Medicaid, Obstetrics, Patient Acceptance of Health Care, Pregnancy, Pregnancy Complications, Primary Health Care, Retrospective Studies, United States, Cohort Studies, Young Adult
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