Exploring How Mothers and Infants Use Preventive Care in Adult and Pediatric Settings

Statement of Problem

There is a growing understanding that preventive care is crucial to improve pregnancy outcomes, decrease health care costs and increase health equity. Yet, only one-third of women report receiving comprehensive preventive care in the year prior to their first birth, and even fewer report receiving such care in between pregnancies. For women, optimizing health in this period may improve outcomes in future pregnancies, improve their long-term cardiovascular health and ensure they have the ability to provide the best care for their child. For infants, their early growth and development predicts how healthy they will be in the future, much of which is dependent on their parents’ health.

In the year following birth, women interact with the health care system both as patients in adult settings and as parents in pediatric settings. Pediatricians are increasingly asked to identify and address maternal health issues such as postpartum depression, yet women may also receive care in adult settings. Despite this overlap, coordination between adult and pediatric settings around preventive health for families is rare, leading to potential gaps in mother-infant services. Establishing ways for pediatric and adult care providers to coordinate on how they deliver preventive care services may improve birth outcomes and the health of both women and babies.

Description

Exploring How Mothers and Infants Use Preventive Care in Adult and Pediatric Settings

38% of mother-infant pairs had no adult preventative visits

These findings demonstrate that pediatric health systems may be well-positioned to provide intergenerational family services to help coordinate preventive care for mothers and their children.

This project addresses the lack of coordination between adult care and pediatrics by identifying preventive care opportunities from the mother-infant dyad perspective in the year after birth. Prioritizing at-risk populations, our study specifically looks at outcomes for women treated for depression, anxiety, obesity, diabetes or hypertension during pregnancy or in the first three months postpartum, and women who had a preterm birth. Children whose parents experience these conditions are more likely to develop the conditions themselves, emphasizing the importance of medical services for these new parents and families.

For the purposes of this analysis, we considered any care billed to the child’s health insurance as pediatric care and any care billed to the mother’s insurance as adult care. During the first part of the study, primary outcomes included looking at the number of preventive visits in the first year after birth including postpartum care, contraception or generalized attention to women’s health risk. Using Medicaid data from almost 600,000 mother-infant pairs, our results showed more preventative visits occurred in pediatric care than adult settings. This signals that while children are receiving preventive care, mothers may be forgoing their own—in fact, 38% of mother-infant pairs did not receive any preventive care in adult settings. Our research also showed those included in the cardiovascular and mental health risk group were more likely to receive adult preventative care than mothers who had a preterm birth or pairs in which mothers had no risk factors.

Next Steps

The results of the first phase of this project characterized missed opportunities for interconception care among high-risk women. However, the findings also demonstrate that with the necessary supports, pediatric health systems may be well-positioned to provide intergenerational family services to help coordinate preventive care for mothers and their children during this critical time period.

In the next phase of this research, we will use the same data to explore how patterns of when mothers and infants seek preventive care in the first year after birth are connected to their health outcomes in the following years. This additional analysis will help us identify whether receiving more preventive care is associated with better health outcomes, such as reducing complications in the next pregnancy and waiting longer between pregnancies.

This project page was lasted updated in April 2020. 

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Exploring How Mothers and Infants Use Preventive Care in Adult and Pediatric Settings [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here]. 

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