Postpartum Healthcare Use Between Two Deliveries and Severe Maternal Morbidity, Michigan, 2009-2015

Severe maternal morbidity (SMM) represents a group of life-threatening conditions of labor and delivery that have short and long-term implications. Current efforts focus on reducing SMM during acute events. Very little research has examined whether postpartum healthcare may complement current efforts. Postpartum healthcare, which includes attending a postpartum visit and receiving contraception, is important for addressing health needs, connecting individuals to needed specialty care and other preventive care such as a well-woman visit, and helping individuals achieve an optimal inter-pregnancy interval. However, there is a dearth of literature on whether postpartum healthcare use differs by SMM-status, whether postpartum healthcare use is associated with reduced risk of subsequent SMM, and whether history of SMM is associated with a change postpartum healthcare use across two deliveries. This study included Michigan residents with at least one, and a subset of individuals with at least two sequential, Medicaid-paid deliveries between October 1, 2009 and September 30, 2015. Data were from maternally linked birth records and Medicaid billing claims. SMM was identified from delivery claims using International Classification of Diseases, 9th Revision, Clinical Modification codes for 16 diagnoses and 5 procedures recommended by the Centers for Disease Control and Prevention. Postpartum healthcare included postpartum visit attendance with or without receipt of most or moderately effective contraception identified in billing claims. Postpartum visit attendance used the Healthcare Effectiveness Data and Information Set’s performance measure. In analysis, either multinomial or binary logistic regression was conducted to calculate predicted margins to generate either risk or rate ratios and 95% confidence intervals. Multivariable models were built using LASSO. Almost half of individuals with at least one Medicaid-paid delivery did not attend a postpartum visit, and postpartum healthcare use did not differ by SMM during delivery. About one-third of individuals with at least two sequential Medicaid-paid deliveries did not attend a postpartum visit after either delivery. Repeat SMM including transfusion was associated with a significantly higher probability of not attending a postpartum visit after either delivery. However, postpartum healthcare use, more specifically attending a postpartum visit and receiving contraception, was associated with a lower rate of subsequent SMM.