Maternal Sociodemographic Characteristics, Experiences and Health Behaviors Associated with Postpartum Care Utilization: Evidence from Maryland PRAMS Dataset, 2012–2013

Abstract

Objectives Postpartum visits are increasingly recognized as a window of opportunity for health care providers to counsel new mothers and promote healthy behaviors, including increasing contraceptive use and screening for postpartum depression. In Maryland, there is a lack of research on postpartum visit (PPV) attendance and the specific risk factors associated with not receiving postpartum care. In this study, we estimated the proportion of mothers in Maryland who attended a PPV and assessed maternal sociodemographic characteristics and health behaviors associated with PPV non-attendance. Methods Data were analyzed from the 2012 and 2013 Maryland Pregnancy Risk Assessment Monitoring System (n = 2204). Bivariate and multivariable logistic regression were performed to examine the association between covariates and PPV non-attendance. Results Overall, 89.6% of women reported PPV attendance. Bivariate analyses between maternal sociodemographic and health behavior characteristics and PPV non-attendance indicated that being unmarried (OR 3.03, 95% CI 2.12-4.31), experiencing infant loss (OR 7.17, 95% CI 2.57-19.97), working during pregnancy (OR 0.44, 95% CI 0.31-0.63) and not receiving dental care (OR 2.03, 95% CI 1.43-2.88) as significant risk factors for PPV non-attendance. After controlling for known and theoretical confounders, experiencing an infant loss (aOR 5.18, 95% CI 1.54-17.4), not receiving dental care (aOR 1.54, 95% CI 1.06-2.26) and working during pregnancy (aOR 0.61, 95% CI 0.41-0.93) emerged as strong predictors of PPV non-attendance. Conclusions for Practice Mothers who recently experienced an infant death were at greatest risk for not attending a PPV, suggesting the need to establish comprehensive support networks, including grief counseling and additional service reminders for mothers who experienced an infant death.

Characteristics associated with loss to post‐partum follow‐up among adolescent mothers

“…This study which focused on the specific group of adolescent mothers found inadequate number of antenatal visits, being single/separated/divorced and lower level of education significantly associated with loss to post‐partum follow‐up. Previous studies also found that being unmarried and inadequate number of antenatal visits (<5 visits) were risk factors for non‐attendance to the post‐partum visit. In a study involving healthy women, higher level of education was identified as a factor associated with post‐partum visit which was consistent with our finding.…”

“…Previous studies also found that being unmarried and inadequate number of antenatal visits (<5 visits) were risk factors for non‐attendance to the post‐partum visit. In a study involving healthy women, higher level of education was identified as a factor associated with post‐partum visit which was consistent with our finding.…”

“…Previous studies showed substantial differences in the rates of post‐partum attendance among women of all reproductive ages with good health or medical disorders during pregnancy . Regarding healthy women, a survey‐based study by Morgan et al .…”

“…Despite recognition of its importance, a post‐partum visit is often neglected by nursing mothers. Data suggested that the rates of post‐partum visits varied substantially, ranging from 29 to 90% …”

“…From a practical perspective, identifying adolescent mothers who are more likely to be lost to post‐partum follow‐up would serve as a checkpoint to alert providers to provide the specialized programs to improve their adherence to the post‐partum visit. Previous studies reported predictive factors of nonattendance to the post‐partum follow‐up visit . However, these studies were conducted among women of various ages consisting of both adolescent and adult women.…”