Associations between health-related social needs and postpartum linkage to care

Introduction: Ongoing care after pregnancy is recommended. Health-related social needs (HRSNs) are recognized barriers to care, yet their pregnancy-related prevalence and associations with care are unknown. Researchers sought to assess (1) the prevalence of HRSNs during pregnancy-based care, and (2) their associations with ongoing care after pregnancy.

Methods: Electronic health record data were analyzed for individuals with prenatal care and delivery (2018-2021) at an urban safety-net hospital, with routine screening for HRSNs multiple times during pregnancy through 6 weeks postpartum. HRSNs were summarized as: screened negative, screened positive, or not screened. Linkage to ongoing care was defined as a completed non-urgent visit separate from pregnancy-based care, >6 weeks through 1 year postpartum. Data were collected in 2022 and analyzed in 2023-2024.

Results: Of 4941 individuals, 53% identified as Black non-Hispanic and 21% as Hispanic, 68% were publicly insured, and 93% completed ≥1 HRSN screening. Nearly 1 in 4 screened positive for HRSNs, and 53% linked to ongoing care. Compared with those who screened negative for HRSNs (n=3491), linkage to ongoing care was similar among those who screened positive (n=1079; adjusted risk ratio, aRR 1.04, 95% confidence interval, CI: 0.98-1.10) and lower among those not screened (n=371; aRR 0.77, 95% CI: 0.68-0.86).

Conclusions: Researchers identified a 24% prevalence of pregnancy-related HRSNs and 53% subsequent linkage to ongoing care. Compared with screening negative for HRSNs, screening positive was not associated with linkage to care, while being not screened was associated with a 20% lower likelihood of linkage to ongoing care.