Characteristics of women without a postpartum checkup among PRAMS participants, 2009–2011
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Introduction For uncomplicated pregnancies in the United States, a healthcare visit 4 to 6 weeks postpartum is recommended to assess a woman’s mental, social, and physical health. We studied whether sociodemographic characteristics and pregnancy and delivery factors were related to the likelihood of missing a postpartum checkup. Methods We conducted a cross-sectional analysis of 64,952 women who completed the United States Centers for Disease Control Pregnancy Risk Assessment Monitoring System (PRAMS) Phase 6 survey in 2009–2011 from 17 states and New York City that included a Yes/No question about receiving a maternal postpartum checkup. We calculated risk ratios (RR) with 95% confidence intervals (CI) to assess the association between maternal factors and lack of a postpartum checkup. Results Compared to women who attended a postpartum checkup (89.4%), women who missed the visit (10.6%) were younger, unmarried, less educated, with lower income, without insurance, and smokers (all p < 0.05). Compared to women with adequate prenatal care, women with intermediate (RR 1.79 (95% CI 1.70–1.88)) or inadequate (RR 2.71 (95% CI 2.53–2.91)) care were more likely to miss the checkup. Women were more likely to miss this checkup if their infant was born at a residence compared to a hospital (RR 2.27 (95% CI 1.71–3.01)), and were less likely to miss the checkup if their newborn had a 1-week well visit (RR 0.70 (95% CI 0.61–0.81)). Discussion Sociodemographic factors and noncompliance with other medical care were associated with missing a postpartum checkup. Women with a high-risk of not attending a postpartum visit should be targeted for interventions to increase their accessibility to care.
KeywordsPostpartum Clinic visit Surveys PRAMS Obstetrics
This study would like to acknowledge the 17 states and 1 city that used the standard question from which our outcome data stems. These places chose to include Question L8 from the PRAMS, which reads: “Since your new baby was born, have you had a postpartum checkup for yourself? (A postpartum check is the regular checkup a woman has about 6 weeks after she gives birth).” These sites are: Arkansas, Georgia, Hawaii, Massachusetts, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Tennessee, Texas, Utah, Washington, West Virginia, Wisconsin, and New York City. We would also like to acknowledge the Center for Disease Control and Prevention (CDC) and the PRAMS Working Group for their permission to use Phase 6 data for the PRAMS, 2009–2011. PRAMS Working Group: Alabama—Izza Afgan, MPH; Alaska—Kathy Perham-Hester, MS, MPH; Arkansas—Mary McGehee, PhD; Colorado—Alyson Shupe, PhD; Connecticut —Jennifer Morin, MPH; Delaware—George Yocher, MS; Florida—Elizabeth C. Stewart, MSPH; Georgia—Florence A. Kanu, MPH; Illinois—Patricia Kloppenburg, MT (ASCP), MPH; Iowa —Sarah Mauch, MPH; Louisiana—Rosaria Trichilo, MPH; Maine—Tom Patenaude, MPH; Massachusetts—Emily Lu, MPH; Michigan—Peterson Haak; Minnesota—Kathy Raleigh, PhD, MPH; Mississippi—Brenda Hughes, MPPA; Missouri—David McBride, PhD; Montana—Emily Healy, MS; Nebraska—Jessica Seberger; New Hampshire—David J. Laflamme, PhD, MPH; New Jersey—Lakota Kruse, MD; New Mexico—Oralia Flores; New York State—Anne Radigan; New York City—Pricila Mullachery, MPH; North Carolina—Kathleen Jones-Vessey, MS; North Dakota—Sandra Anseth; Ohio—Connie Geidenberger, PhD; Oklahoma—Ayesha Lampkins, MPH, CHES; Oregon—Claudia W. Bingham, MPH; Pennsylvania—Tony Norwood; Rhode Island—Karine Tolentino Monteiro, MPH; South Carolina—Mike Smith, MSPH; Texas—Tanya Guthrie, PhD; Tennessee—Ramona Lainhart, PhD; Utah—Nicole Stone; Vermont—Peggy Brozicevic; Virginia—Christopher Hill, MPH, CPH; Washington—Linda Lohdefinck; West Virginia—Melissa Baker, MA; Wisconsin—Christopher Huard; Wyoming—Lorie Chesnut, PHD.
Funding was provided by Agency for Healthcare Research and Quality (Grant No. K01HS025013), National Institute of Child Health and Human Development (Grant No. 5K12HD050108).
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