Inadequate Postpartum Care May Drive Poor Moms to ER

Low-income moms who suffer from complications during pregnancy are using the emergency room (ER) at high rates after delivery, according to a new analysis at Johns Hopkins. The researchers suggest this may be due to inadequate postpartum care and follow-up that could have prevented further health problems.

Johns Hopkins researchers reported that Medicaid-insured, low-income women with gestational diabetes, gestational hypertension, or preeclampsia during their pregnancies were more likely to have an ER visit in the six months following birth than those without such complications. Their analysis looked at more than 26,000 Maryland Medicaid claims.

In particular, women under 25 years old were at the greatest risk of going to the ER after a complicated pregnancy. Also, the majority of ER visits occurred before the recommended six-week postpartum appointment, indicating the need for earlier postpartum follow-up for women with pregnancy complications.

“Our results offer clues to opportunities to improve the postpartum and longer-term health of many low-income women,” said study lead author Ashley Harris, M.D., M.H.S., a senior clinical fellow in the Johns Hopkins University School of Medicine’s Division of General Internal Medicine.

“Further study might lead to interventions and programs that target these women for intensive discharge planning and follow-up care that could improve access to care and prevent ER use,” she said.

Medicaid, like most forms of insurance, covers a postpartum visit six weeks after childbirth. However, said Harris, many women — particularly those who rely on government-sponsored programs such as Medicaid — face multiple social and economic barriers that cause them to miss these visits. These might include a lack of child care, schedule demands, difficulty accessing care, and lack of understanding about the long-term health risks tied to pregnancy complications.

Instead of getting care at regular checkups, Harris said, some patients turn to the ER, where care is more costly, less efficient, less equipped to deal with chronic conditions or able to promote long-term preventive health behaviors.

Of the 26,047 women in the study, all of whom had pregnancies under Medicaid, about 20 percent experienced complications such as gestational diabetes, gestational hypertension, or preeclampsia.

Overall, about a quarter of all the patients visited the ER within six months of delivery. However, the researchers’ analysis shows that those who had experienced one or more of the three pregnancy complications considered for the study were 14 percent more likely to go to the ER than those who didn’t have these complications.

Importantly, being under 25 years old increased the odds of an ER visit by 20 percent. Furthermore, 60 percent of the ER visits that occurred among these women were prior to the commonly recommended six-week visit and continued on well after.

In addition, having a cesarean delivery or having any of the identified preconception health issues further increased the chances that those with complicated pregnancies would seek care at the ER (a 24 percent and 63 percent increase, respectively), the authors say.

Co-author Wendy Bennett, M.D., M.P.H., an assistant professor of medicine at Johns Hopkins, said possible interventions could include early postpartum home or community-based visits that not only address recent pregnancy complications, but also promote long-term health behavior changes (such as postpartum weight loss and contraception needs) and address some of the social challenges, such as health care access and housing.

Bennett is currently studying the practicality and impact of joint maternal-child visits, in which new mothers bring their babies for well-baby checkups and receive their own checkups at the same time.

“In our study, patients are thrilled that they are able to get their own postpartum care and their baby’s care at the same time, and then they get all their questions answered, sort of like one-stop shopping,” Bennett said.

“This is a large and potentially captive group of women who could benefit from further study of effective postpartum interventions that minimize preventable ER visits,” said Bennett.

The findings are published in the Journal of Women’s Health.

Source: Johns Hopkins Medicine
Woman in hospital photo by shutterstock.