Department of Pediatrics, Division of General Pediatrics.
Department of Pediatrics, Division of Neonatology, Children's Hospital of Philadelphia.
Med Care. 2020 Jun;58(6):519-525. doi: 10.1097/MLR.0000000000001310.
Following birth, women may access preventive care in adult settings or, with their infants, in pediatric settings. Preventive care can improve future birth outcomes and long-term health, particularly for women with health risks.
This cohort study linked mother-infant Medicaid claims from 12 states for 2007-2011 births. Pregnancy claims identified health risk categories: maternal cardiovascular (diabetes, hypertension, pre-eclampsia, obesity), maternal mental health (depression, anxiety), and premature birth. Claims for 1 year following birth identified adult and pediatric preventive visits. Logistic regression assessed the relationship between visits and risks, adjusting for maternal demographics, perinatal health care utilization, year, and state.
Of 594,888 mother-infant dyads with Medicaid eligibility for 1 year following birth, 36% had health risks. In total, 38% of all dyads, and 33% with health risks, had no adult preventive visits. Dyads had a median of 1 (IQR, 0-2) adult and 3 (IQR, 2-5) pediatric preventive visits. A total of 72% of dyads had more preventive visits in pediatric than adult settings. In regression, preterm birth was associated with lower odds of any adult preventive visits [odds ratio (OR), 0.97; 95% confidence interval (CI), 0.95-0.99], and maternal health risks with higher odds (cardiovascular OR, 1.19; 95% CI, 1.18-1.21; mental health OR, 1.87; 95% CI, 1.84-1.91), compared with dyads without risk.
Maternal health risks were associated with increased adult preventive visits, but 38% of dyads had no adult preventive visits in the year following birth. Most dyads had more opportunities for preventive care in pediatric settings than adult settings.
女性在分娩后可以选择在成人医疗机构或与婴儿一起在儿科医疗机构接受预防保健。预防保健可以改善未来的分娩结果和长期健康，尤其是对于存在健康风险的女性。
本队列研究将来自 12 个州的 2007-2011 年分娩的母婴医疗补助索赔进行了链接。妊娠索赔确定了健康风险类别：产妇心血管疾病（糖尿病、高血压、子痫前期、肥胖症）、产妇心理健康问题（抑郁、焦虑症）和早产。产后 1 年的索赔确定了成人和儿科预防保健就诊情况。使用逻辑回归评估了就诊情况与风险之间的关系，同时调整了产妇人口统计学特征、围产期保健服务的利用情况、年份和州等因素。
在分娩后有资格获得医疗补助 1 年的 594888 对母婴中，有 36%的母婴存在健康风险。在所有母婴中，有 38%、在有健康风险的母婴中，有 33%未进行任何成人预防保健就诊。母婴中位数就诊次数为 1 次（IQR，0-2），儿科就诊次数中位数为 3 次（IQR，2-5）。共有 72%的母婴在儿科就诊次数多于成人。在回归分析中，早产与任何成人预防保健就诊的可能性降低相关[比值比（OR），0.97；95%置信区间（CI），0.95-0.99]，而产妇健康风险与可能性增加相关（心血管 OR，1.19；95% CI，1.18-1.21；心理健康 OR，1.87；95% CI，1.84-1.91），与无风险的母婴相比。
产妇健康风险与增加成人预防保健就诊相关，但在分娩后 1 年内，仍有 38%的母婴未进行任何成人预防保健就诊。大多数母婴在儿科医疗机构的预防保健机会多于成人医疗机构。
