Overview of Included Studies on Follow-Up After Discharge From Childbirth Facilities

StudyStudy Location, Design, Population, and Sample SizeStudy Outcome(s)Data Collection Method, Person Making Contact, Timing of Postpartum Contact, and PersistenceResponseOther Comments
1.1. Studies using primarily home visits for follow-up
Aftab 202130

Bangladesh, India, Pakistan, DRC, Ghana, Kenya, Tanzania, Zambia Prospective cohort of 125,716 pregnant individuals

Direct maternal morbidity and mortality, stillbirth, and neonatal deathHome visits by trained workers at week 1 and between week 7 and 11 after delivery; persistence not reported.91% visited at least onceStudy also included 3 home visits during pregnancy.
Creanga 201631

Kenya Prospective cohort of 1,185 pregnant individuals

Intentions and behaviors regarding maternal and neonatal health service utilizationHome visits by trained interviewers up to week 6 after delivery; persistence not reported.89%Study also included 2 home visits during pregnancy.
Darmstadt 201032

Bangladesh Cluster RCT of 10,006 neonates

Neonatal illness and survivalHome visits by CHWs at days 2, 5, 8, and 28 after delivery; persistence not reported.73% visited at least onceStudy included 2 home visits during pregnancy. CHWs attended the delivery if possible and facilitated referral if necessary.
Surkan 201733

Bangladesh Prospective cohort within a cluster RCT of 59,666 pregnant individuals

Maternal morbidity and postpartum depressionHome visits by trained interviewers at months 3 and 6 after delivery; persistence not reported.96% with depression data at 6 months
Ward 200834

United Kingdom Prospective cohort of 6,297 individuals with a CD

CD surgical site infectionRoutine home visits by community midwives (median length of follow-up: 15 days after delivery); persistence not reported.88% with completed follow-up records
1.2. Studies using primarily clinic visits for follow-up
Srun 201335

Cambodia Prospective cohort of 222 individuals with a CD

CD superficial surgical site infectionClinical assessment of wound by nurses and surgeons during inpatient stay and 2 scheduled clinic visits post-discharge at days 15 and 30 after delivery (microbiological methods used); phone follow-up by surgeons if patients didn’t return.86% (Day 15) and 80% (Day 30) across all methods9% (17/190) of those reached on day 15 were contacted by phone (on day 30: 16% (29/176)). 36% (4/11) of superficial infections were diagnosed post-discharge.
Zejnullahu 201936

Kosovo Prospective cohort of 420 individuals with a CD

CD surgical site infectionRoutine clinic visit (day 30) with gynecologists and additional outpatient department follow-up up to day 30 (microbiological methods used); persistence not reported.77%
1.3. Studies using in-person visits for follow-up (location not specified)

Surveillance Monitoring for Antiretroviral Toxicities Yee 202137

United States Prospective dynamic cohort (recruitment ongoing) of 2,976 pregnant individuals and individuals after delivery who are living with HIV (2007–2019)

Substance use in caregivers (wider study looks at health of children and their caregivers)In-person structured interviews conducted by trained interviewers up to week 1 and at month 12 after delivery; persistence not reported.98% (Week 1), 60% (Month 12)
2. Studies using primarily telephone calls for follow-up
Bianco 201338

Italy Prospective cohort of 1,705 individuals after delivery

Postpartum infectionTelephone calls by 2 physicians (trained, not involved in patient care) at day 30 after discharge (medical records for validation); 5 attempts.97%Telephone surveillance identified more infections (8.9%) than traditional infection surveillance systems (1.4%).
Cardoso Del Monte 201039

Brazil Prospective cohort of 204 individuals with a CD

CD surgical site infectionTelephone calls by study investigator and trained student nurse at days 15 and 30 after delivery; 3 attempts at each time point.92%
Hacker 202240

United States Prospective cohort of 10,092 individuals after delivery

Hypertensive disordersTelephone calls by a nurse or patient educator (and self-administered blood pressure measurement if cuff available) at week 1 after delivery; persistence not reported.59%
Halwani 201641

United States Prospective cohort of 193 individuals with a CD

CD surgical site infectionTelephone calls by study investigator at days 7, 14, and 30 after delivery; 3 attempts at each time point.82% interviewed at least once. 65% interviewed 3 times.Incidence of infections detected by telephone 10% (19/193) compared to 7% (14/193) by traditional surveillance.
Hill 202142

United States Prospective cohort of 631 individuals with a positive COVID-19 test during their hospital stay after delivery (individuals who tested negative were also included at 1 site)

Well-being of COVID-19 patients

Hospital records and telephone calls after discharge by physicians and clinical nurses up to week 2 after discharge (2 calls per week; first call within 3 days after discharge); persistence not reported.

36% reached a least once
Lima 201643

Brazil Prospective cohort of 528 individuals with a CD

CD surgical site infectionTelephone calls by trained undergraduate students up to day 15 and up to day 30 after delivery; 5 calls at each time point.67% contacted at least once. 30% on day 15, 63% on day 30.
Nguhuni 201744

Tanzania Prospective cohort of 316 individuals with a CD

CD surgical site infectionTelephone calls by a clinically trained investigator or nurse at days 5, 12, 28 after delivery (clinical reviews for validation); at least 2 attempts.87% reached at least once85% of enrolled women provided a telephone number. Compared to clinical reviews, sensitivity and specificity of phone interviews was 72% and 100%, respectively.

PRAMS Salvesen von Essen 202245

Puerto Rico Prospective cohort of individuals with a live birth: 1,536 (Phase 1), 1,485 (Phase 2)

Maternal and infant postpartum (ill-) health and behaviors (partly Zika-related)Telephone calls by 6 interviewers at month 3 after delivery (Phase 1) and month 9 after delivery (Phase 2); persistence not reported.77% (Phase 1), 83% (Phase 2)Telephone surveys followed standard PRAMS protocol procedures.

Swissnoso SSI surveillance system Troillet 201746

Switzerland Prospective cohort of 187,501 surgery patients including 32,814 individuals with a CD

Surgical site infectionTelephone calls by infection control nurses at 1 month after operation; 5 attempts.91% for individuals with a CD87% of CD surgical site infections diagnosed after discharge.
Woodd 202147

Tanzania Prospective cohort of 879 individuals after delivery

Maternal postnatal infections and newborn infectionsTelephone calls by research nurses (2 per hospital) at days 7 and 28 after delivery; 4 attempts over 7 days.90% interviewed at least once. 86% interviewed on day 28.3% of the initial sample had no access to a telephone.
3.1. Studies using self-administered postal questionnaires for follow-up

The Norwegian Mother and Child Cohort Study Magnus 201648 Bjelland 201649

Norway Prospective cohort of 112,908 pregnant individuals

Maternal and child healthSelf-administered postal questionnaire at month 6 after delivery; persistence not reported.80% (Month 6)Study also included additional questionnaires sent during pregnancy, at 18 months after delivery and later in childhood.

NorwayProspective cohort of 20,248 pregnant individuals without pelvic pain in pregnancy

85% (Month 6)

PRAMS Shulman 201850 Kortsmit 202251

United States Prospective cohort of individuals with a live birth (Annual state sample size: 1,000–3,000)

Maternal behaviors, attitudes, and experiencesSelf-administered postal questionnaire with sampling taking place at months 2 to 6 after delivery; telephone follow-up for non-responders, 5 mailings and 15 call attempts.47%–74% (median = 61%; in 2014)

United States Prospective cohort of 347,363 individuals with a live birth stratified by whether infant is alive or deceased

48.3% if infant is deceased, 56.2% if infant is alive
Williams 200752

United KingdomCross-sectional survey of 2,100 individuals after delivery

Perineal morbiditySelf-administered postal questionnaire at month 12; reminder after 3 weeks.23%
3.2. Studies using self-administered electronic questionnaires for follow-up
Hirshberg 201853

United StatesRCT of 206 individuals after delivery with pregnancy-related hypertension

Blood pressure monitoringText messages with individuals responding to automated text messages sent by web-based platform up to week 2 after discharge; 2 requests for blood pressure readings per day.92% submitted at least 1 reading in the first 10 days postpartumTexting reached more individuals than standard clinic visits (92% compared to 44%).
Zhu 202154

ChinaProspective cohort of 674 individuals after delivery belonging to the rural-to-urban floating population

Self-efficacy, postpartum depression, and social supportSelf-administered electronic questionnaire distributed via email or WeChat at weeks 6 and 12 after delivery; WeChat reminders 1 week and 1 day before data collection time points.81% (Week 6), 65% (Week 12)
4. Studies using a combination of methods for follow-up
Baxter 202155

EnglandRepeated point-prevalence study (4 time points) of 1,639 individuals with a CD

CD surgical site infectionInpatient and re-admission cases identified via electronic records. Post-discharge cases identified via telephone and text messages (1st time point: telephone; 2nd–4th time point: text messages with telephone follow-up). Program led by midwife with infection control experience. Timing of contact not reported; 3 attempts for telephone calls.47%–68% across all methods (1st time point: 60%, 2nd: 47%, 3rd: 68%, 4th: 60%)Small quality improvement initiatives between time points. As accuracy of telephone numbers improved, response rates increased to 74%.

MINA-Brazil CohortCardoso 202056Mosquera 201957

BrazilProspective cohort of 1,246 pregnant individuals and individuals after delivery

Growth and development of Amazonian childrenLinkage to hospital records, telephone calls (up to month 3), and study visits (from month 6 on) conducted by trained fieldworkers (including research assistants and nurses) on days 30 to 45, and months 3, 6 and 12 after delivery; multiple phone calls to schedule assessment and text message reminders before clinic visit.64% (Month 6), 63% (Month 12)Study also included visits during pregnancy, after delivery in hospital, and later during childhood (year 2 and planned for year 5).

BrazilProspective cohort of 1,523 pregnant individuals and individuals after delivery

63% (Day 30–45)3% of women did not provide valid telephone number.
Ferraro 201658

ItalyProspective cohort of 3,685 individuals with a CD (4 time points)

CD surgical site infectionRoutine clinic visit or telephone calls up to day 30 after delivery. Person making contact not reported; persistence not reported.94% across all methods and time points89% (129/145) of infections were diagnosed post-discharge.
Madhi 201859

Panama, Dominican Republic, South Africa, MozambiqueProspective cohort of 3,243 pregnant individuals

Maternal and infant access to health care facilitiesVisit to study site and, if necessary, telephone calls or home visits up to day 30. Person making contact not reported; persistence not reported.98%Study also included data collection at time of delivery.
Opøien 200760

NorwayProspective cohort of 326 individuals with a CD

CD surgical site infectionWound inspection in hospital by study authors, patients instructed to monitor symptoms and contact hospital, and self-administered postal questionnaire up to day 30 after delivery; reminders sent to non-responders and telephone follow-up if necessary.100%Incidence of infections detected by day 30 was 9% (29/326) compared to 2% detected before discharge.
  • Abbreviations: CD, cesarean delivery; CHW, community health worker; DRC, Democratic Republic of Congo; PRAMS, Pregnancy Risk Assessment Monitoring System; RCT, randomized controlled trial.