Barriers to postpartum care and how to overcome them

Adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm birth, fetal growth restriction, and others, are recognized as early indicators of future cardiovascular and metabolic disease. Despite this, postpartum care remains fragmented, attendance rates remain suboptimal, and transitions from obstetric to longitudinal primary care frequently fail, particularly among individuals at highest risk. As a result, a critical opportunity for disease prevention is often missed. This review examines barriers to effective postpartum care and evaluates evidence-based strategies to improve postpartum care and subsequently long-term health outcomes. Barriers exist at multiple levels, including patient, provider, and system. Patient-level barriers include competing caregiving demands, limited awareness of future health risks, mental health challenges, and logistical constraints. Provider-level barriers include inadequate knowledge of the long-term implications of APOs, competing clinical priorities, and fragmented care transitions. System-level barriers include insurance discontinuity, poor integration between obstetric and primary care services, and lack of accountability for longitudinal follow-up. Health inequities driven by structural and social determinants of health further exacerbate these challenges. To facilitate implementation, we propose a pragmatic tiered framework that prioritizes interventions according to evidence strength, scalability, and equity impact. High-priority strategies include remote blood pressure monitoring, extension of postpartum insurance coverage, and risk-stratified referral pathways. Additional approaches include patient navigation, mother-infant combined care models, home-visiting programs, and digital health interventions. The postpartum period should be viewed not as the end of pregnancy care but as a critical window for chronic disease prevention. Implementing scalable, evidence-based postpartum care models has the potential to improve maternal health trajectories and reduce the long-term burden of cardiometabolic disease following APOs.