Abstract
Introduction
Pregnant individuals with cardiometabolic conditions—including diabetes, hypertensive disorders, and obesity—are at elevated risk for postpartum complications. Timely postpartum care is critical for mitigating postpartum risks, yet postpartum visit attendance remains suboptimal, and few evidence-based interventions exist, especially among those receiving care in safety-net health systems. We aimed to evaluate whether a patient-centered postpartum care planning intervention increases comprehensive postpartum visit attendance among obstetric patients with at least one cardiometabolic risk factor.
Methods
We conducted a single-center, parallel group randomized control trial at a metropolitan safety-net health system, enrolling pregnant individuals who were 20–34 weeks gestation, English or Spanish-speaking, and had a diagnosis of diabetes mellitus, chronic hypertension, gestational diabetes, gestational hypertension or preeclampsia, and/or pre-pregnancy obesity. Participants were randomized 1:1 to receive standard obstetric care (control) or standard obstetric care plus prenatal education and co-creation of a postpartum care plan (intervention). The primary outcome was attendance at a comprehensive postpartum visit between 4 and 12 weeks postpartum. We used generalized linear models to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for the intervention using an intent-to-treat approach, stratified by parity.
Results
We randomized 159 participants to the intervention and 161 to the control arms (N = 320). Overall, 52.8% and 55.3% of participants in the intervention and control arms, respectively, attended a comprehensive postpartum visit (p = 0.66). When stratified by parity, no differences were seen among primiparous participants (61.5% vs. 50.0%; RR, 1.23; 95% CI, 0.82–1.85) or multiparous participants (48.6% vs. 56.6%; RR, 0.86; 95% CI, 0.67–1.10). For multiparous participants, among those receiving one or no prenatal study visits with a research coordinator, only 29.6% attended a comprehensive postpartum visit, whereas 72.4% of those with ≥3 visits did so (p = 0.001).
Conclusion
The patient-centered postpartum care planning intervention did not significantly improve postpartum visit attendance. However, attendance rates were higher among those with greater prenatal intervention exposure, suggesting that intensity and continuity of patient engagement may improve postpartum care utilization.