How payers can improve maternal care in the 4th trimester

Many people think of childbirth as the most dangerous part of pregnancy, but that’s not actually the case. Despite significant advances in medicine and pregnancy support, the maternal mortality rate in the United States remains alarmingly high: more than half (53%) of pregnancy-related deaths occur between 7 days and one year after birth, according to the CDC.¹

Likewise, preconception is a period that is both critical and often overlooked.

With so much attention devoted to improving maternal outcomes,² it’s important to recognize the impact of better care both before conception and extending through the postpartum period. By applying a wider lens to support women through these periods that bookend pregnancy and birth, health plans and employers can dramatically improve our nation’s maternal health.

A healthy pregnancy starts well before the first prenatal visit. Prepregnancy appointments allow women to work with their providers to diagnose and manage chronic conditions, such as hypertension and diabetes, to minimize the risk of pregnancy complications and reduce preterm births.³

Just as crucially, establishing regular health care before a pregnancy gives women and their partners the time and support needed to build healthy habits. For example, doctors now recommend avoiding alcohol for at least 6 months before conception. And quitting smoking is important before pregnancy, as nicotine reduces the quality of both sperm and eggs, in addition to increasing health risks.³

New research further underscores just how important it is for women to optimize their health before becoming pregnant. Prepregnancy lifestyle coaching focused on physical activity and nutrition can reduce the risk of developing gestational diabetes.⁴

Notably, studies suggest that women with better mental health prior to conception are more likely to engage in positive health behaviors and seek timely prenatal care once pregnant, further improving maternal and fetal health.⁴

Research shows that women’s mental health tends to remain stable from preconception into pregnancy.⁴ Effectively managing conditions such as depression and anxiety before becoming pregnant is associated with fewer symptoms and lower risk of adverse outcomes during pregnancy.

Across the physical and mental care continuum, payers have a unique opportunity to improve access and normalize regular preconception care. By using comprehensive health information and robust data analytics, they can identify reproductive-age members at elevated risk of both chronic conditions and mental health concerns. They can also offer streamlined solutions to help individuals receive the education, preventive services and ongoing health management they need.

Mental health disorders such as suicide and opioid overdose are responsible for nearly 1 in 4 maternal deaths in the U.S. This is almost double the rate from postpartum hemorrhage, the second most common culprit.⁵

During the first year after giving birth, women are at a higher risk for new psychiatric disorders and 14.5% develop a new episode of depression, according to the Agency for Healthcare Research and Quality. Yet only 1 in 5 women are screened for postpartum depression. It’s estimated that more than half of pregnant women with depression don’t receive treatment.⁵

The rising prevalence of couples using assisted reproductive technology to get pregnant and the fact that more women are having children later in life may contribute to postpartum behavioral health issues.⁶ 

Researchers at the University of Virginia School of Medicine found that women over the age of 40 who have twins are at markedly higher risk for postpartum depression,⁶ while a 2023 study found that parents who conceived after IVF treatment also had a higher risk.⁷ At the same time, many women are losing access to postpartum care due to obstetric unit closures and workforce shortages and could benefit from remote patient monitoring.

Payers have a critical role to play in addressing these barriers to care. They can leverage data analytics to pinpoint women at higher risk, triggering timely screenings and providing 24/7 support resources for new mothers. To increase access to postpartum care, health plans should offer programs that augment in-person offerings with telehealth appointments and digital resources. And they should ensure benefits are keeping pace with maternal-health innovations, whether that means incorporating remote monitoring device breakthroughs⁸ or covering the first oral medication to treat postpartum depression (approved by the FDA in 2023).⁹

Maternal outcomes in the U.S. already constitute a public health crisis² — and they’re getting worse. But it doesn’t have to be this way. 

A multifaceted, holistic approach can improve health before, during and after pregnancy:

• Offer preparation and guidance toward a healthier pregnancy
• Identify, monitor and manage chronic conditions as early as possible
• Provide postpartum coaching and continuous access to clinical perinatal experts

With these approaches, payers can drive meaningful impact — and create a better future for parents and babies alike.