Bridging the Postpartum Gap: A Randomized Controlled Trial to Improve Postpartum Visit Attendance Among Low-Income Women with Limited English Proficiency

Polk, Sarah; Edwardson, Jill; Lawson, Shari; Valenzuela, Doris; Hobbins, Elisabetta; Prichett, Laura; Bennett, Wendy L

doi:10.1089/whr.2020.0123

Cited by 10 publications

(15 citation statements)

References 23 publications

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“…1). We screened 589 full-text articles and included 64 studies (80 articles, 17–96 ) in the current systematic review. Follow-up in the earliest study began in 1989 and in the last study ended in 2021.…”

Section: Resultsmentioning

confidence: 99%

Delivery Strategies for Postpartum Care

Saldanha,

Adam,

Kanaan

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To systematically review the effects of postpartum health care–delivery strategies on health care utilization and maternal outcomes. DATA SOURCES: We searched Medline, EMBASE, CENTRAL, CINAHL, and ClinicalTrials.gov for studies in the United States or Canada from inception to November 16, 2022. METHODS OF STUDY SELECTION: We used duplicate screening for studies comparing health care–delivery strategies for routine postpartum care on health care utilization and maternal outcomes. We selected health care utilization, clinical, and harm outcomes prioritized by stakeholder panels. TABULATION, INTEGRATION, AND RESULTS: We found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). For general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (summary effect size 1.36, 95% CI 1.13–1.64) (moderate strength of evidence). Location of breastfeeding care did not affect hospitalization, other unplanned care utilization, or mental health symptoms (all low strength of evidence). Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3–6 months (summary effect size 1.10–1.22) but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months (summary effect size 1.43, 95% CI 1.07–1.91) but not exclusive breastfeeding (all moderate strength of evidence). Use and nonuse of information technology for breastfeeding care were associated with comparable rates of breastfeeding (moderate strength of evidence). Testing reminders for screening or preventive care were associated with greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A1c testing (moderate strength of evidence). CONCLUSION: Various strategies have been shown to improve some aspects of postpartum care, but future research is needed on the most effective care delivery strategies to improve postpartum health. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022309756.

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Section: Resultsmentioning

confidence: 99%

Delivery Strategies for Postpartum Care

Saldanha,

Adam,

Kanaan

et al. 2023

Obstetrics &Amp; Gynecology

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“…54 Previous programs that have shown some promise in improving rates of postpartum follow-up among individuals with HDP include transition clinics, utilization of patient navigators, home visiting programs, integration of postpartum care with pediatric visits (MommyBaby Visits), and use of telehealth and remote BP monitoring. [61][62][63][64][65][66][67][68] Specifically, home-based BP monitoring is associated with improved BP surveillance within the first 10 days postpartum and lower mean BP by 4/7 mm Hg up to 4 years after delivery. 63,69 Some have also suggested that home-based BP monitoring could be implemented as a screening tool for masked or whitecoat hypertension when used either before or complementary with ambulatory BP monitoring based on data showing moderate-to-high agreement between BP measurements obtained from these techniques during 1 to 4 years postpartum.…”

Section: Opportunities For Hypertension and Cvd Prevention During The...mentioning

confidence: 99%

Chronic Hypertension in Pregnancy: A Lens Into Cardiovascular Disease Risk and Prevention

Cameron¹,

Everitt

Lee³

et al. 2023

Hypertension

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Hypertension is a major, modifiable risk factor for cardiovascular disease (CVD) in the United States. Over the past decade, the prevalence of chronic hypertension (CHTN) during pregnancy has nearly doubled with persistent race- and place-based disparities. Blood pressure elevations are of particular concern during pregnancy given higher risk of maternal and fetal morbidity and mortality, as well as higher lifetime risk of CVD in birthing individuals with CHTN. When identified during pregnancy, CHTN can, therefore, serve as a lens into CVD risk, as well as a modifiable target to mitigate cardiovascular risk throughout the life course. Health services and public health interventions that equitably promote cardiovascular health during the peripartum period could have an important impact on preventing CHTN and reducing lifetime risk of CVD. This review will summarize the epidemiology and guidelines for the diagnosis and management of CHTN in pregnancy; describe the current evidence for associations between CHTN, adverse pregnancy outcomes, and CVD; and identify opportunities for peripartum care to equitably reduce hypertension and CVD risk throughout the life course.

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“…The responsibility of identifying, counseling, and managing long-term risks should be shared by a multidisciplinary Cardio-Obstetrics team [ 33 •, 77 ]. A co-located, co-timed maternal postpartum and newborn preventive care visit (“mommy-baby visit”) has been proposed to improve postpartum visit attendance rates [ 78 ]. In a randomized controlled trial comparing mommy-baby visits and enhanced usual care (staff assisted scheduling of postpartum visit before hospital discharge) in 116 postpartum women with limited English proficiency, postpartum visit attendance rates were high (> 90%) in both groups [ 78 ].…”

Section: A Time For Transitions In Care: Models For Improvementmentioning

confidence: 99%

“…A co-located, co-timed maternal postpartum and newborn preventive care visit (“mommy-baby visit”) has been proposed to improve postpartum visit attendance rates [ 78 ]. In a randomized controlled trial comparing mommy-baby visits and enhanced usual care (staff assisted scheduling of postpartum visit before hospital discharge) in 116 postpartum women with limited English proficiency, postpartum visit attendance rates were high (> 90%) in both groups [ 78 ]. This study demonstrated feasibility and acceptability of a co-located, co-timed maternal-newborn visits.…”

Section: A Time For Transitions In Care: Models For Improvementmentioning

confidence: 99%

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care

Choi

Timlin

Varma

et al. 2022

Curr Cardiovasc Risk Rep

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Purpose of Review The “fourth trimester” concept, defined as the first 12 weeks after delivery (and beyond), is a critical window of time for clinicians to intervene to optimize women’s cardiovascular health after pregnancy. A timely and comprehensive postpartum cardiovascular assessment should be performed in all women following delivery in order to (1) follow up medical conditions present prior to conception, (2) evaluate symptoms and signs of common postpartum complications, and (3) identify risk factors and prevent future adverse cardiovascular outcomes. In this review, we aim to discuss major maternal cardiovascular risk factors such as hypertensive disorders of pregnancy, gestational diabetes mellitus, postpartum weight retention, and postpartum depression, as well as lactation as a potential protective risk modifying factor. Additionally, we will review effectiveness of outpatient interventions to enhance transitions in cardiovascular care during the fourth trimester. Recent Findings A seamless hand-off from obstetric to primary care, and potentially cardiology, is needed for early detection and management of hypertension, weight, glycemic control, stress and mood, and long-term cardiovascular risk. Additionally, the use of telemedicine, blood pressure self-monitoring, remote activity monitoring, and behavioral health coaches are potentially feasible modalities to augment clinic-based care for cardiovascular risk factors and weight management, but additional studies are needed to study their long-term effectiveness. Summary Development of a comprehensive postpartum care plan with careful consideration of each patient’s risk profile and access to resources is critical to improve maternal morbidity and mortality, reduce health disparities, and achieve long-term cardiovascular health for women. Supporting postpartum well-being of women during this transition period requires a multidisciplinary approach, especially primary care engagement, and planning should start before delivery.

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Bridging the Postpartum Gap: A Randomized Controlled Trial to Improve Postpartum Visit Attendance Among Low-Income Women with Limited English Proficiency

Cited by 10 publications

References 23 publications

Delivery Strategies for Postpartum Care

Delivery Strategies for Postpartum Care

Chronic Hypertension in Pregnancy: A Lens Into Cardiovascular Disease Risk and Prevention

The Fourth Trimester: a Time for Enhancing Transitions in Cardiovascular Care

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