Degree Name
DrPH (Doctor of Public Health)
Program
Public Health
Date of Award
5-2025
Committee Chair or Co-Chairs
Nathan L Hale
Committee Members
Michael Grady Smith, Bethesda Jo Ann O'Connell
Abstract
Introduction Gestational diabetes (GDM) and gestational hypertension (GH) are significant public health issues with lasting implications for maternal and child health (MCH). Despite clinical guidelines recommending postpartum care for all women, especially those with chronic conditions, less than 50% receive a visit within 12 months of childbirth. Recent policy changes extend postpartum Medicaid coverage from 60 days to 12 months. This study assessed differences in postpartum care visits by race/ethnicity and geography after the extension of postpartum coverage in South Carolina. Methods A retrospective cohort of 27,056 women (aged 20-44) who gave birth in 2021 were analyzed using Medicaid claims data. Primary outcomes included visit to any postpartum care, primary care, and obstetrics care further stratified into different time-periods. Independent variables included race/ethnicity and geographical location. Key Informant Interviews (KIIs) were conducted with MCH key partners to verify postpartum coverage expansion in South Carolina.
Results Aim 1 KIIs confirmed the implementation of the extended Medicaid postpartum coverage. However, provider and beneficiary awareness gaps, enrollment barriers, and communication issues were identified. Aim 2 Overall, 63.72% of women utilized postpartum care within 12 months. Proportion of visits among non-Hispanic White mothers (70.38%) was higher than non-Hispanic Other (62.4%) and Hispanic (31.3%; p<0.001) mothers. Adjusted analysis noted a substantial lower odds of postpartum visits among Hispanic (AOR: 0.21; 95% CI: 0.17-0.25) mothers. Women residing in rural areas (66.57%) had higher odds (AOR: 1.11; 95% CI: 1.05-1.18) of postpartum care visits compared to urban residents (62.58%). Individuals with GDM (66.09%) and GH (71.01%) were more likely (AOR:1.17; 95% CI: 1.07-1.27 and AOR: 1.49; 95% CI: 1.39-1.58, respectively) to utilize postpartum care compared to those without these conditions. Aim 3 No significant differences were found in postpartum care utilization between rural and urban groups within racial categories. However, larger disparities between urban White and both rural and urban Hispanic women were seen, suggesting that racial disparities in postpartum care are more pronounced than geographic ones among women with chronic conditions. Conclusion The extension of Medicaid Postpartum Coverage doesn’t seem sufficient, targeted interventions are needed to address both racial/ethnic and geographic disparities in postpartum care utilization.
Document Type
Dissertation - embargo
Recommended Citation
Dahal, Kajol, "Racial and Geographic Disparities in Primary Care Transitions for Postpartum Women with Gestational Diabetes and Hypertension in South Carolina" (2025). Electronic Theses and Dissertations. Paper 4519. https://dc.etsu.edu/etd/4519
Copyright
Copyright by the authors.
