More questions
Dr. Celi, who spoke on the panel, runs a clinic that helps people transition back to a primary care provider after a hypertensive pregnancy. She said that she wants to help clinicians better manage the shift.
Clinicians can probe patients on how much sleep they’re getting and whether a support system is present back at home. These are all related to the recovery process, and Dr. Celi recommended that clinicians encourage their patients to prioritize asking for help from external sources.
“Bring in your community: ‘Do you have some best friends from work or somebody who might be able to help with meals? Is there someone in the family that could travel to help [you] as [you’re] recovering? Is the father of the baby involved? Can he help?’ ” said Dr. Celi, offering question suggestions for clinicians to ask.
Dr. Celi recommends that clinicians prescribe hypertensive-friendly birth control options as part of a follow-up care plan, such as progestin-only birth control pills.
She also recommends that clinicians evaluate women with a history of preeclampsia 3-6 months after a birth for cardiovascular risk factors, with an annual follow-up on blood pressure, body mass index, fasting glucose or A1c, and lipids.
Follow-up care
“At least 40% of people don’t even make it to that 6-week visit, and we lose them,” Dr. Zera said. “It turns out, having a pregnancy complication does not make it any more likely that you’re going to come to your postpartum visit.”
For some patients, insurance coverage often changes after delivery. For example, in states without a Medicaid extension or expansion, the program is only required to provide 60 days of coverage after delivery. Even among patients with commercial insurance, churn rates are high. People may quit their jobs and switch to the partner’s insurance or get a new job with a different insurance plan. If the new insurance doesn’t include the patient’s established clinician, the patient may switch clinicians or skip the follow-up appointment entirely.
Another barrier to care is patients feeling like their doctors don’t care about them, Dr. Zera said.
“This is kind of simple stuff, but bond with your patients,” she said. “Tell them, ‘I want to see you when you’re pregnant and beyond,’ because that makes a huge difference.”
No relevant financial relationships were reported.
A version of this article first appeared on Medscape.com.