(804) Impact of Infant Gestational Age at Birth on Postpartum Healthcare Receipt

Up to 40% of obstetric patients do not attend postpartum visits. Birthing parents of preterm infants are often sicker than those of full-term infants. Yet parents of preterm infants may forgo postpartum visits to be present in the neonatal intensive care unit (NICU). We evaluated whether parents of preterm infants were less likely to receive postpartum care than parents of full-term infants.

Study Design: Retrospective cohort study of births in Epic Systems’ Cosmos research platform (2018-2023), a US-based electronic health record database with anonymized, de-identified, patient-level data. We explored bivariate associations of infant gestational age with postpartum visits. Logistic regression models estimated the odds of missing postpartum visits among parents of infants of varying gestational ages compared to parents of full-term infants (39-40 weeks). Models first adjusted for patient characteristics (age, parity, body mass index, race and ethnicity, insurance, smoking, year, and CDC Social Vulnerability Index), and then adjusted for morbidities (diabetes, hypertension, and cesarean birth) (Table 1).

Results:

In bivariate analyses, parents of infants < 24 weeks’ gestation missed postpartum visits significantly more often than parents of full-term infants (37% vs. 32%, respectively, OR 1.26 [1.13 – 1.40]) (Table 2). Adjustment for patient characteristics did not meaningfully change estimates. However, with adjustment for morbidities, parents of preterm infants in every gestational age category had significantly higher odds of missing postpartum visits compared to parents of full-term infants; adjusted odds ratios ranged from 1.11 (1.06 – 1.17) to 1.20 (1.08 – 1.33) among parents of infants 24-27 and < 24 weeks’ gestation, respectively.

Conclusion: Parents of preterm infants are at higher risk for not receiving postpartum healthcare than parents of full-term infants. Interdisciplinary, innovative approaches to deliver care to this high-risk group, potentially in the NICU, are needed.