724 Association of poor access to care with new diagnosis of chronic hypertension postpartum

Abstract

Cardiovascular disease (CVD) is the leading cause of death among women. ACOG recommends a 6-12 month CVD assessment for women with a gestational complication, such as hypertensive disorder of pregnancy (HDP). Data are limited regarding the benefit of this additional assessment. We aimed to determine the effect of poor access to care on new chronic hypertension (cHTN) 6-12 months postpartum. Our prospective cohort study included women with singletons and a HDP and normotensive women who delivered full term with no complications (non-HDP). Those with chronic medical conditions identified prior to pregnancy were excluded. All underwent a health assessment 6-12 months after delivery and completed a survey on barriers to care including self-reported obstacles and the use of assistance services. Multivariable logistic regression was used to assess the association between poor access to care and new cHTN 6-12 months postpartum. Of 109 women, 46 (42%) had cHTN at 6-12 months; 12 (26%) had no HDP and 34 (74%) had a HDP. 86 women (79%) were unable to obtain medically-indicated tests or treatments. The 3 most commonly self-reported barriers were: childcare (44%), cost (25%), and inability to obtain timely care (25%). Twice the number of women who developed cHTN self-identified as homeless (Table 1). Women with a delay in care during the postpartum period had an almost 4-fold increased risk of developing cHTN (aOR 3.95, CI 1.07-14.57) when adjusting for HDP, insurance, marital status, education, and smoking. However, with inclusion of BMI as an adjustment in the multivariable regression, the effect was attenuated (aOR 2.79, CI 0.54-13.32) (Table 2). Poor access to care is associated with an increased risk of cHTN 6-12 months postpartum, regardless of a HDP. Although the effect is attenuated by BMI, it is critical to investigate the role of access, obesity and disparities on the development of cHTN beyond only recommending women with placental syndrome receive follow-up. An important next step may be the expansion of Medicaid for 12 months postpartum.View Large Image Figure ViewerDownload Hi-res image Download (PPT)