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Low-income women not receiving postpartum care they need

Researchers said the specific needs of the population insured by Medicaid should be considered when crafting standards of care.

By Stephen Feller

BALTIMORE, Sept. 25 (UPI) -- Medicaid-insured women with complications during their pregnancies were found in a large study to use the emergency room after delivery at higher rates and may not be getting the postpartum care they need to prevent health problems.

Researchers suggest hospitals should re-examine hospital discharge plans and earlier postpartum care as it relates to lower-income women, at least possibly because the standard six-week follow-up visit after delivery may not be enough to address their issues.

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"Our results offer clues to opportunities to improve the postpartum and longer-term health of many low-income women," said Dr. Ashley Harris, a senior clinical fellow at the Johns Hopkins University School of Medicine, in a press release. "Further study might lead to interventions and programs that target these women for intensive discharge planning and follow-up care that could improve access to care and prevent ER use."

Researchers analyzed data on 26,074 pregnancies among women using the Maryland Medicaid program for every live birth between 2003 and 2010. The data included outpatient, inpatient, and ER visits during pregnancy, six months before becoming pregnant, and one year after delivery.

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Of the pregnancies, researchers found 20 percent were complicated by gestational diabetes, gestational hypertension or preeclampsia. In the six months postpartum, 25 percent of all the women insured by Medicaid had at least one visit to the emergency room.

The women who'd had one of the three complications during pregnancy were found to be 14 percent more likely to go to the ER than those who did not have one, and mothers under the age of 25 were 20 percent likely to do so. Of the visits, 60 percent were before the generally-recommended six-week visit.

The researchers said postpartum patients may need more care than they are given, or different care, based on social and economic factors such as lack of childcare, schedule demands, difficulty accessing care and lack of understanding about the long-term health risks associated with pregnancy complications.

They also suggest either making the visits mother and child, or even sending care providers to the women in order to mitigate other challenges, could help to improve services and care, while decreasing expensive visits to the emergency room.

The study is published in the Journal of Women's Health.

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