Postpartum care utilization among high-risk pregnancies in an urban safety-net health system

The postpartum period carries substantial risk for preventable morbidity, particularly among individuals with high-risk pregnancies complicated by chronic or pregnancy-associated conditions. Despite recommendations for early and ongoing postpartum follow-up, patterns of postpartum and acute care utilization across high-risk conditions remain poorly characterized. We evaluated postpartum and acute care utilization among individuals with high-risk pregnancies versus low-risk pregnancies in an urban safety-net health system.

We conducted a retrospective cohort study of individuals who delivered at two campuses of a tertiary academic medical center between 1 June 2018 and 31 May 2022. High-risk pregnancy status was defined using ICD-9/10 codes corresponding to chronic medical or pregnancy-associated conditions; low-risk was defined by the absence of these codes. The primary outcome was attendance of ≥1 postpartum visit (PPV) within 12 weeks of delivery. Secondary outcomes included emergency department (ED) visits and hospital readmissions within 12 weeks postpartum. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs).

Of 13,874 included individuals, 9435 (68.0%) had ≥1 high-risk diagnosis, and nearly half had multiple coexisting conditions. High-risk individuals were more likely than low-risk individuals to attend any PPV (59.2% vs. 45.4%) and an early PPV within 21 days (40.5% vs. 24.2%, both p < 0.001). ED visits (16.9% vs. 13.9%) and readmissions (5.4% vs. 2.7%) were also more frequent among high-risk individuals (p < 0.001). In adjusted analyses, hypertensive disorders of pregnancy (aOR 1.67), mental health conditions (aOR 1.49), cesarean delivery, and greater prenatal care utilization were associated with higher odds of PPV attendance, while gestational diabetes was associated with lower odds (aOR 0.79). High-risk conditions, particularly hypertensive disorders and pregestational diabetes, were associated with increased acute care utilization.

Although high-risk individuals were more likely to attend PPVs, overall engagement remained suboptimal and acute care utilization was high. These findings highlight the need for risk-tailored postpartum care and improved care coordination to reduce preventable morbidity.