Assessing the high-risk pregnant woman at home

Perinatal Nurse Home Visiting Referral Patterns Among Women With Diabetes and Hypertension in Philadelphia

OBJECTIVE

To examine access to perinatal nurse home visiting services for high-risk pregnant women who have diabetes or hypertension.

DESIGN

Secondary data analysis.

SETTING

Philadelphia, PA.

PARTICIPANTS

Pregnant women who had a live birth during 2012 and those referred to a community-based agency for perinatal nurse home visiting because of their diagnosis of diabetes or hypertension.

METHODS

Access to services was measured by examining referral information (dosage, diagnosis, gestational age at time of referral, and insurance type) retrieved from administrative logs of the community-based organization that provides perinatal home visiting to high-risk pregnant women. The population-based prevalence rates of hypertension and diabetes were calculated from birth record data provided by the Philadelphia Department of Public Health.

RESULTS

During 2012, 595 pregnant women were referred for perinatal nurse home visiting services. The mean gestational age when referred for services was 24.9 weeks (standard deviation = 8.5) with a mean number of 8.8 authorized visits (standard deviation = 8). Associated with more authorized visits was having Medicaid as the insurance type and medical diagnoses that included hypertension (p < .01). Philadelphia prevalence rates for diabetes and hypertension varied by race and ethnicity (p < .001); Asian mothers had the greatest rates for diabetes and Black mothers the greatest rates for hypertension.

CONCLUSION

Various models of home visiting programs exist to improve maternal and child health outcomes. Because maternal morbidity and mortality rates are rising in the United States, further research about perinatal nurse home visiting programs for pregnant women with diabetes and hypertension is warranted.