1371 Department of Epidemiology, Emory University, Atlanta, GA, USA.
Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA.
Public Health Rep. 2022 May-Jun;137(3):516-524. doi: 10.1177/00333549211005814. Epub 2021 Apr 19.
Limited evidence suggests racial/ethnic disparities in postpartum visit attendance; however, little is known about patterns in postpartum visit content. We sought to determine whether receipt of screening and counseling varies by race/ethnicity and whether cardiovascular disease (CVD) risk (preconception or pregnancy related) predicts postpartum visit content.
We used data from the Pregnancy Risk Assessment Monitoring System 2016-2017 (39 sites) to calculate the prevalence of self-reported receipt of screening, services, and counseling at the postpartum visit by race/ethnicity and CVD risk (unweighted analytic sample n = 59 427). We created a score representing receipt of 5 key screenings or messages at the visit (counseling on healthy eating and exercise, cigarettes, pregnancy spacing, and birth control methods; screening for depression), which we used as a binary indicator of visit content in regression models. We fit a logistic regression model to determine the magnitude of association between CVD risk and receipt of the 5 key messages, prevention screening, or CVD-specific counseling (on healthy eating and exercise, smoking), adjusting for maternal age, race/ethnicity, and health insurance status.
Overall, 40% of women reported receiving all CVD-specific prevention messages. Both prepregnancy and pregnancy-related CVD risk were associated with increased odds of receipt of CVD prevention messages (adjusted odds ratios [aOR] = 1.2; 95% CI, 1.1-1.3; and 1.1; 95% CI, 1.1-1.2, respectively). Race/ethnicity was a stronger predictor than CVD risk: non-Hispanic Black women were twice as likely as non-Hispanic White women to receive CVD prevention messages, regardless of CVD risk (aOR = 1.9; 95% CI, 1.7-2.0).
Health systems should consider novel strategies to improve and standardize the content of postpartum visits.
有限的证据表明，产后访视存在种族/民族差异；然而，对于产后访视内容的模式知之甚少。我们旨在确定种族/民族差异是否会影响筛查和咨询的获得，以及心血管疾病（CVD）风险（孕前或妊娠相关）是否预测产后访视内容。
我们使用了 2016-2017 年妊娠风险评估监测系统（39 个站点）的数据，根据种族/民族和 CVD 风险（未加权分析样本 n = 59427）计算了产后访视时自我报告的筛查、服务和咨询的获得率。我们创建了一个代表在访视时获得 5 项关键筛查或信息的分数（关于健康饮食和运动、香烟、妊娠间隔和避孕方法的咨询；筛查抑郁症），我们将其用作回归模型中访视内容的二进制指标。我们拟合了逻辑回归模型，以确定 CVD 风险与获得 5 项关键信息、预防筛查或 CVD 特定咨询（关于健康饮食和运动、吸烟）之间的关联程度，调整了产妇年龄、种族/民族和医疗保险状况。
总体而言，40%的女性报告接受了所有 CVD 特定预防信息。孕前和妊娠相关 CVD 风险均与 CVD 预防信息获得的可能性增加相关（调整后的优势比[aOR] = 1.2；95%置信区间[CI]，1.1-1.3；和 1.1；95%CI，1.1-1.2）。种族/民族比 CVD 风险更能预测：无论 CVD 风险如何，非西班牙裔黑人女性获得 CVD 预防信息的可能性是非西班牙裔白人女性的两倍（aOR = 1.9；95%CI，1.7-2.0）。
卫生系统应考虑新的策略来改善和规范产后访视的内容。
