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Jump to Key Points Automatically scheduling postpartum primary care checkups for pregnant patients with anxiety or depression significantly boosts the mental health support they receive, according to a recent study published in JAMA Network Open.
While clinical guidelines encourage continuous mental health screening and care throughout the entire postpartum year, most women struggle to reestablish primary care during the critical transition period after frequent ob/gyn visits end.
“My co-primary investigator on this work had a pregnancy complicated by preeclampsia and then experienced this struggle and this kind of postpartum cliff herself,” said Mark Clapp, MD, MPH, associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School in Boston, who co-led the study. “What this study demonstrated was that default scheduling into a primary care visit was incredibly feasible.”
Postpartum patients often experience a sharp decline in care, transitioning from routine prenatal visits to minimal follow-up. This sudden drop-off leaves critical conditions developed during pregnancy, such as hypertension and mood disorders, frequently unaddressed.
- Default postpartum PCP scheduling ↑ primary care visits at 4 months (43.5% vs 28.9%).
Postpartum depression and anxiety affects approximately 1 in 7 women and can occur any time in the year following delivery. Screening for the conditions throughout the postpartum year is encouraged by the American Academy of Family Physicians.
Clapp and colleagues sought to investigate whether having an ob/gyn practice schedule a primary care visit on the patient’s behalf could increase screening, counseling, treatment, and referrals to specialists.
The secondary analysis analyzed data from a clinical trial conducted at one hospital clinic and five community-based clinics of 266 patients (average age, 33.7 years; 75.6% White) who already had a diagnosis of anxiety, depressive mood disorder, or both, between November 2022 and October 2023.
Roughly half of intervention participants received appointment reminders via text with messaging about the importance of reestablishing a relationship with their primary care clinician. Control group participants were responsible for scheduling their own visits.
Four and 12 months after the expected delivery date, researchers reviewed electronic health records within the health system to track primary care visits and documentation for mental health services. Participants filled out a survey at 5 months to assess self-reported receipt of the services.
More patients in the intervention by 4 months had a primary care visit (43.5% vs 28.9% control patients) and a documented discussion around mental health concerns (39.9% vs 24.2%, P < .001) and received a mental health screening (33.3% vs 15.6%) than control group participants.
Intervention group participants were more likely to self-report discussing mental health within primary care visits (59.8% vs 40.4%) and being prescribed treatment and receiving referrals to a specialist (23.2% vs. 10.1%, P = .03).
Although Clapp said the intervention offers a cost-effective way to facilitate patients’ transition to primary care, some clinic labor is involved. Ob/gyns cannot wait until the 6-week postpartum checkup to talk to patients about the transition to primary care and call primary care practices to make appointments themselves.
Other barriers to postpartum care also persist, said Reshma Khanna, DO, a perinatal psychiatrist at MU Health Care in Columbia, Missouri.
“Naturally, mom is meeting really high demands taking care of a newborn, and then there might be multiple children in the home to where she needs childcare so she’s able to go to those appointments,” Khanna said. Additionally, “many moms have to go back to work after pregnancy, and there are financial constraints associated with that as well.”
One way to reduce financial costs is to book appointments as annual physicals, often covered by insurance as preventive care, Clapp said.
“Going into that postpartum period, that contact [with clinicians] definitely decreases but their needs absolutely don’t decrease with it,” Khanna said.
The study was funded by the National Institute on Aging and the National Academy of Medicine’s Health Catalyst Award. Clapp and Khanna reported having no relevant financial conflicts of interest.
Kelsey Mesmer, PhD, is a freelance journalist and journalism professor at Saint Louis University in St. Louis.
