Racial and Geographic Disparities in Primary Care Transitions for Postpartum Women with Gestational Diabetes and Hypertension: A Medicaid Claims Analysis in South Carolina

Additional Authors

Nathan Hale, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Michael Smith, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN. Bethesda O’Connell, Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN.

Abstract

The ACOG recommends that all women receive postpartum care within three weeks of childbirth, followed by ongoing care and a comprehensive visit by 12 weeks. While Medicaid now covers postpartum care for 12 months in 49 states, postpartum transitions remain underexplored, particularly among women with gestational diabetes (GDM) and gestational hypertension (GH). Racial/ethnic and geographic differences in these transitions are not well understood. This study analyzes Medicaid claims in South Carolina to assess how race and location impact postpartum care utilization among mothers with GDM and GH. Methods: A retrospective cohort of 27,056 Medicaid-insured women (ages 20-44) who gave birth in South Carolina in 2021 was analyzed. Medicaid claims identified transitions to postpartum, primary, and obstetric care within 1-3, 4-6, and 7-12 months postpartum. Independent variables included race/ethnicity and geographic location. Results: Overall, 63.72% attended a postpartum visit. Women with GDM (AOR = 1.17) and GH (AOR = 1.49) had higher odds of postpartum care. Rural women had greater postpartum (AOR = 1.11), primary (AOR = 1.15), and obstetric care utilization (AOR = 1.07). Non-Hispanic White women had the highest, whereas Hispanic (AOR = 0.21) and non-Hispanic Other women (AOR = 0.70) had the lowest postpartum care utilization. Conclusion: Despite Medicaid expansion, disparities persist in postpartum care access. Rural non-Hispanic Black women had the highest chronic condition prevalence, while Hispanic and non-Hispanic Other women had lower postpartum care transitions. Findings emphasize the need for targeted interventions to improve postpartum healthcare access.

Start Time

16-4-2025 9:00 AM

End Time

16-4-2025 10:00 AM

Room Number

311

Presentation Type

Oral Presentation

Presentation Subtype

Grad/Comp Orals

Presentation Category

Health

Faculty Mentor

Nathan Hale

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Racial and Geographic Disparities in Primary Care Transitions for Postpartum Women with Gestational Diabetes and Hypertension: A Medicaid Claims Analysis in South Carolina

311

The ACOG recommends that all women receive postpartum care within three weeks of childbirth, followed by ongoing care and a comprehensive visit by 12 weeks. While Medicaid now covers postpartum care for 12 months in 49 states, postpartum transitions remain underexplored, particularly among women with gestational diabetes (GDM) and gestational hypertension (GH). Racial/ethnic and geographic differences in these transitions are not well understood. This study analyzes Medicaid claims in South Carolina to assess how race and location impact postpartum care utilization among mothers with GDM and GH. Methods: A retrospective cohort of 27,056 Medicaid-insured women (ages 20-44) who gave birth in South Carolina in 2021 was analyzed. Medicaid claims identified transitions to postpartum, primary, and obstetric care within 1-3, 4-6, and 7-12 months postpartum. Independent variables included race/ethnicity and geographic location. Results: Overall, 63.72% attended a postpartum visit. Women with GDM (AOR = 1.17) and GH (AOR = 1.49) had higher odds of postpartum care. Rural women had greater postpartum (AOR = 1.11), primary (AOR = 1.15), and obstetric care utilization (AOR = 1.07). Non-Hispanic White women had the highest, whereas Hispanic (AOR = 0.21) and non-Hispanic Other women (AOR = 0.70) had the lowest postpartum care utilization. Conclusion: Despite Medicaid expansion, disparities persist in postpartum care access. Rural non-Hispanic Black women had the highest chronic condition prevalence, while Hispanic and non-Hispanic Other women had lower postpartum care transitions. Findings emphasize the need for targeted interventions to improve postpartum healthcare access.