Objectives: Compared to other developed countries, the US has the highest maternal mortality and high prevalence of pregnancy-related complications. Postpartum care (PPC) focused on chronic disease management is potentially lifesaving, especially among pregnancies complicated by risk factors such as diabetes, hypertension, and mental health conditions (MHCs). The objective of this study was to determine if there is a relationship between maternal mortality risk factors and receipt of PPC among Texas Medicaid enrollees.

Methods: Pregnant women (ages 12-55) continuously enrolled in Texas Medicaid with a delivery between 3/25/2014-10/31/2019 were followed 84 days pre-delivery to 60 days post-delivery. PPC was defined as ≥1 visit associated with postpartum follow-up, postpartum services, or office visits for non-acute care within 60 days of delivery identified using ICD-9, ICD-10, and procedure codes. Maternal mortality risk factors (diabetes, hypertension, and MHCs) during and after pregnancy were identified using ICD-9/ICD-10 codes and medication utilization. Age, race/ethnicity, cesarean delivery, and preterm birth served as covariates. Multivariable logistic regression was used to address the study objective.

Results: The sample (N=617,010) was 26.5±5.7 years old, primarily (52.8%) Hispanic, 33.0% cesarean deliveries, and 9.3% preterm births. Risk factor prevalence included: diabetes (14.0%), hypertension (14.3%), MHCs during pregnancy (6.3%), and MHCs after pregnancy (9.1%). A majority (N=480,583; 77.9%) had a PPC visit within 60 days of delivery. The odds of receiving PPC were 1.2 times higher for patients with diabetes (OR=1.183, 95% CI=1.161-1.206;p<.0001), 1.1 times higher for patients with hypertension (OR=1.109, 95% CI=1.089-1.130;p<.0001), and 1.1 times higher for patients with MHCs (OR=1.138, 95% CI=1.108-1.170;p<.0001) than patients without, respectively.

Conclusions: This real-world study revealed that over three-quarters of Texas Medicaid pregnant enrollees received PPC within 60 days of delivery and that risk factors were prevalent. Targeted interventions to provide comprehensive PPC for patients with chronic conditions may help reduce maternal mortality in Texas.