Patterns of Postpartum Ambulatory Care Follow-up Care Among Women With Hypertensive Disorders of Pregnancy.
Patterns of Postpartum Ambulatory Care Follow-up Care Among Women With Hypertensive Disorders of Pregnancy.
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DOI：
10.1161/jaha.120.016357
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发表时间：
2020-09
影响因子：
5.4
通讯作者：
Groeneveld PW
中科院分区：
文献类型：
--
作者：
Lewey J;Levine LD;Yang L;Triebwasser JE;Groeneveld PW
先兆子痫和妊娠期高血压是妊娠期高血压疾病 (HDP)，会增加日后患慢性高血压和心血管疾病的风险。产后随访可能有助于心血管危险因素的早期筛查和治疗。我们的目标是描述具有全国代表性的商业保险女性样本中患有和未患有 HDP 的女性的产后就诊模式，包括初级保健和妇女保健提供者（例如家庭医学和产科）。我们利用美国健康保险数据库中的保险索赔进行了一项回顾性队列研究，以描述产后 6 个月内就诊的模式。我们确定了 2005 年至 2014 年间完成妊娠的 566 059 名女性。在 6 个月时，13% 的血压正常妊娠女性、18% 的 HDP 女性和 23% 的慢性高血压女性接受了初级保健（将 HDP 组和慢性高血压组与对照参与者进行比较，P<0.0001）。只有 58% 的 HDP 女性接受过任何连续性提供者的 6 个月随访，而无高血压女性的这一比例为 47%（P<0.0001）。在多变量分析中，患有严重先兆子痫的女性进行产后连续性随访的可能性高出 16%（调整后的比值比，1.16；95% CI，1.2-1.21）。与随访可能性较低相关的因素包括年龄≥30岁、黑人种族、西班牙裔和多胎妊娠。妊娠合并高血压后的连续性护理随访率较低。这代表着严重错失了为未来心血管疾病风险增加的女性提供心血管风险筛查和管理的机会。
Preeclampsia and gestational hypertension are hypertensive disorders of pregnancy (HDP) that identify an increased risk of developing chronic hypertension and cardiovascular disease later in life. Postpartum follow‐up may facilitate early screening and treatment of cardiovascular risk factors. Our objective is to describe patterns of postpartum visits with primary care and women's health providers (eg, family medicine and obstetrics) among women with and without HDP in a nationally representative sample of commercially insured women. We conducted a retrospective cohort study using insurance claims from a US health insurance database to describe patterns in office visits in the 6 months after delivery. We identified 566 059 women with completed pregnancies between 2005 and 2014. At 6 months, 13% of women with normotensive pregnancies, 18% with HDP, and 23% with chronic hypertension had primary care visits (P<0.0001 for comparing HDP and chronic hypertension groups with control participants). Only 58% of women with HDP had 6‐month follow‐up with any continuity provider compared with 47% of women without hypertension (P<0.0001). In multivariable analysis, women with severe preeclampsia were 16% more likely to have postpartum continuity follow‐up (adjusted odds ratio, 1.16; 95% CI, 1.2–1.21). Factors associated with a lower likelihood of any follow‐up included age ≥30 years, Black race, Hispanic ethnicity, and having multiple gestations. Rates of continuity care follow‐up after a pregnancy complicated by hypertension were low. This represents a substantial missed opportunity to provide cardiovascular risk screening and management to women at increased risk of future cardiovascular disease.