(836) The postpartum cliff: Gaps in postpartum follow-up among individuals with hypertensive disorders

Individuals with hypertensive disorders of pregnancy (HDP) are at risk of short- and long-term adverse sequelae. To mitigate risks, national guidelines recommend that patients with HDP have two postpartum follow-up visits with obstetrics (within 3 weeks and between 3 to 12 weeks) and transition to primary care or cardiology within 1 year. We examined adherence to these guidelines and whether they differed by HDP groups in a nationwide cohort.

Study Design:

We analyzed data from live births between 2014-2021 in the U.S. Merative^TM MarketScan^® Commercial Database. Hypertensive disorders were identified by diagnosis codes and categorized into mutually exclusive groups: severe HDP, mild HDP, and chronic hypertension (without preeclampsia). Provider visits were identified by provider specialty and outpatient visit MarketScan^® codes, and classified as Obstetrics (physicians and midwives), primary care (Internal, Family, or Preventative Medicine), and Cardiology. Multivariable modified Poisson regression models were conducted to estimate associations between HDP groups and presence of follow-up visits.

Results:

Among 922,535 individuals, 167,539 (18%) people had any HDP. 4% had severe HDP, 12% had mild HDP, and 2% had chronic hypertension without preeclampsia. Follow-up rates at the 3-12 week obstetric visit ranged from 14-18% (Figure 1). Compared to individuals without HDP, rates of obstetric visits were higher across all HDP groups, most notable for the severe HDP group within 3 weeks (5% vs 15%, aRR: 2.62, 95% CI: 2.55-2.70) (Table 1). Similar results were seen for the 3-12 week obstetric visit and primary care and cardiology visits within 1 year postpartum. Follow-up with primary care within 1 year was most notable in those with chronic hypertension compared to those without (60% vs 44%; aRR: 1.26, 95% CI: 1.25-1.28).

Conclusion:

Follow-up intervals across all groups, including patients with severe HDP, were much lower than recommended by national guidelines. Strategies to improve postpartum follow-up and transition to primary care and cardiology are needed to mitigate risks for patients with HDP.