Predictors for follow-up among postpartum patients enrolled in a clinical trial

Abstract

ObjectiveTo identify risk factors for failure to attend postpartum follow-up within 3 months of delivery, including social support, intrinsic motivation, insurance type and prenatal care attendance. Study designThis planned secondary analysis is derived from a randomized controlled trial of patients intending intrauterine device (IUD) use following their delivery (n=197). Subjects were postpartum from a vaginal or cesarean birth at ≥32 weeks’ gestation. We obtained baseline demographics and certainty about their plan to receive a postpartum IUD. We administered validated scales for social support and intrinsic motivation at enrollment. We then reviewed health records for prenatal visits and any postpartum visit by 3 months and performed logistic regression to assess for predictors of follow-up. ResultsA total of 38/197 subjects (19.3%) failed to attend any postpartum visit by 3 months. Subjects who failed to follow up were more likely to have Medicaid versus private insurance (92% versus 8%, p<.01). Income <$50,000, no car, younger age, unplanned pregnancy, unemployment, multiple children, missed prenatal visits and late initiation of prenatal care were also associated with failure to follow up. Higher scores for social support and goal-directed motivation were not significantly associated with follow-up. ConclusionsIn our cohort, we found that one in five participants did not attend a postpartum visit by 3 months. Several socioeconomic indicators are associated with loss to follow-up, most notably Medicaid insurance. Having high motivation and social support is not sufficient to predict successful follow-up. ImplicationsThe main predictors for not attending a postpartum visit are Medicaid insurance or limited prenatal care, and not social support or intrinsic motivation. Interventions to improve postpartum contraception uptake should focus efforts on provision of immediate postpartum contraception for this population.