(265) Postpartum healthcare receipt after spontaneous and medically indicated preterm birth

ACOG reports that up to 40% of patients do not attend a postpartum visit. Parents of preterm infants are at higher risk for not receiving postpartum care than those of term infants, but are often sicker with conditions such as hypertensive disorders and postpartum depression. Preterm birth (PTB) can be classified as spontaneous PTB (sPTB) (i.e., premature rupture of membranes or preterm labor) and medically indicated PTB (mPTB) (i.e., clinician-initiated due to maternal or fetal conditions). We compared postpartum visit attendance after sPTB and mPTB to term birth.

Study Design:

Retrospective cohort study of births from 2010-2019 in GeoBirth, a curated dataset of all births in two hospitals in Philadelphia, PA. Each PTB was manually classified by two blinded reviewers as sPTB or mPTB. We performed bivariate analyses and multivariable, modified Poisson regression models to calculate risk ratios (RR) of no postpartum care receipt after sPTB and mPTB compared to term birth. Models adjusted for age, parity, hospital, body mass index, insurance, education, race and ethnicity, cesarean birth. A linear combination test was used to compare RRs between PTB subtypes.

Results:

Of the 69,493 included births, 3,489 (5.0%) were sPTB, 2,770 (4.0%) were mPTB. 696 unclassified PTBs were excluded. Overall, 33.5% had no postpartum visit within 6 weeks, with higher proportions among sPTB (42.8%) and mPTB (38.8%) than term birth (32.8%) (P< 0.001) (Table 1). Compared to term birth, the unadjusted risk of no postpartum care was higher after sPTB (RR 1.30, 95%CI: 1.24-1.37) than mPTB (RR 1.18, 1.11-1.26) (p value comparing RRs = 0.015) (Table 2). In model including all covariates, risk was similarly elevated for both sPTB (aRR 1.16, 1.10-1.22) and mPTB (aRR, 1.10, 1.03-1.17) (p value comparing RRs = 0.206).

 

Conclusion:

Compared to term births, individuals with both sPTB and mPTB are at higher risk of not attending postpartum visits, despite elevated comorbidity prevalence. Innovative, collaborative, multidisciplinary efforts are essential to meet the needs of this vulnerable population, especially within the NICU.