Health before & beyond pregnancy: an analysis of preconception health, maternity care bundled payments, and long-term maternal cardiovascular health

Abstract

This thesis takes a population-oriented approach to improving health before, during, and after pregnancy. Using quantitative methods and routine care data (or suitable substitutes), and combining insights from multiple disciplines, it examines preconception health, payment reform in maternity care, and cardiovascular risk after pregnancy.

First, the findings reveal a clear need for health optimization before pregnancy: nine in ten women have at least one preconception risk factor, and most are becoming more common. Second, to improve health during pregnancy, changing provider payment incentives in maternity care is not enough by itself. Payment reform should be embedded in a coherent transition strategy with stable long-term policy, room for local variation, and monitoring that evolves with each phase. Third, to improve health after pregnancy, adverse pregnancy outcomes strongly predict hypertension and cardiovascular disease, especially among vulnerable groups. Proactive screening uncovers cardiovascular risk factors in over half of screened women, yet a gap persists between guidelines and practice in cardiovascular risk management.

Overall, the thesis underlines the importance of identifying and supporting high-risk subgroups, fostering cross-sectoral collaboration, and aligning incentives and organizational structures. Continued learning from both successes and failures is crucial for sustainable improvements in health before and beyond pregnancy.