394: The fourth trimester in high deprivation areas: Are we missing the highest risk patients?

Abstract

The postpartum period is increasingly recognized as a critical time when women need access to medical care but may be lost to follow-up. SMFM and ACOG recently reinforced the “fourth trimester” as a critical component of both pregnancy care and life-long health for women. We aimed to examine the association between area deprivation index (ADI) and receipt of postpartum care (PPC) to test how race and other risk factors may inform targeting populations at highest risk of falling out of PPC. This is a prospective cohort study enrolling pregnant women early in pregnancy and following them longitudinally at a tertiary care center in Missouri. ADI was calculated using the “Neighborhood Atlas” developed by the University of Wisconsin, which uses census data to rank areas based on multiple measures of socioeconomic disadvantage such as income, education, employment, housing quality etc. ADI was calculated using Missouri state data based on the woman’s residential address at enrollment. Receipt of PPC was examined across ADI quartiles from least (1st quartile) to most (4th quartile) disadvantaged. Patient-level variables including race, stress levels, depression scores, and medical comorbidities were tested for effect modification in the relationship between deprivation and PPC. 848 pregnant women were included. Women are significantly less likely to receive PPC as deprivation levels increased, from 90% in areas of lowest deprivation to only 64% in areas of highest deprivation. Black race did not significantly modify this relationship although notable disparities exist with black women were less likely to receive PPC than non-black women in both areas of low (67.4% versus 91.5%) and high deprivation (64% versus 71%). 40% of women in areas of highest deprivation fall out of care during the postpartum period. There is also racial disparity in PPC with black women significantly less likely to receive PPC than non-black women in both areas of low and high deprivation. ADI can identify specific geographic regions where targeted interventions to improve PPC would be highest yield.View Large Image Figure ViewerDownload Hi-res image Download (PPT)