WASHINGTON, DC (August 25, 2026)—Guidelines recommend primary care after pregnancy for those who experience complications during pregnancy, and policy changes such as the Affordable Care Act’s Medicaid expansion and the more recent extension of postpartum Medicaid for a full year could improve access to primary care after pregnancy. But have the guidelines and policy changes resulted in more use of primary care in the year after pregnancy for those who need it most? In a study selected as the Editor’s Choice for the July/August Women’s Health Issues, the authors examined health care utilization after pregnancy among privately and publicly insured individuals with and without medically complicated pregnancies.
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at the Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.
Ceshae Harding, MD, MPH, of Wake Forest University School of Medicine; Erica Eliason, PhD, MPH, of the Rutgers School of Public Health; and colleagues used Medical Expenditure Panel Survey data from 2016-2022 to identify different types of health care utilization during the 12 months after childbirth. They compared use of care in individuals with hypertension, pre-existing diabetes, and gestational diabetes — a group they describe as having “medically complicated pregnancies” — and individuals without these conditions.
The authors found that for those both with and without medically complicated pregnancies, primary care usage in the first postpartum year was low throughout the study period. The proportion of postpartum individuals with any primary care in the year following childbirth ranged from 25% (in 2020) to 38% (in 2018) and averaged 33% over the 7-year period. The proportions of people who had primary care and OB/GYN visits in the year after giving birth were similar between the groups with and without medically complicated pregnancies and across demographic groups. More of the medically complicated pregnancy group had emergency room visits in the first postpartum year (21%, compared to 13% of those without the examined cardiometabolic complications).
“Our findings support the existence of multifactorial systemic barriers to primary care after pregnancy that affect individuals of all demographic groups, leaving those with elevated cardiometabolic risk most vulnerable to unmediated disease progression,” Harding and colleagues write. “Greater investment is needed in identifying, testing, and implementing effective interventions to improve primary care engagement in the postpartum year.”
“Guidelines and coverage expansions represent important steps forward, but we need to examine the outcomes to see whether they deliver all the improvements in care across the postpartum year that we hoped for,” said Karen McDonnell, Editor-in-Chief of Women's Health Issues and Associate Professor of Prevention and Community Health at Milken Institute SPH. “This study shows that existing efforts to improve access to postpartum primary care might be necessary, but they aren’t sufficient on their own — so we need to keep working to make sure everyone who gives birth can access postpartum and long-term preventive care.”
“Primary Care Utilization After Pregnancies Complicated by Hypertension and Diabetes: An Analysis of the Medical Expenditure Panel Survey From 2016-2022” has been published in the July/August 2026 issue of Women’s Health Issues.