Frequent ED Visits and Risk for Severe Maternal Morbidity

TOPLINE:

Pregnant individuals, particularly younger and Hispanic or non-Hispanic Black women, with four or more visits to the emergency department (ED) in the United States are more likely to experience severe maternal morbidity (SMM) at the time of birth.

METHODOLOGY:

• Researchers conducted a cohort study using data from the Massachusetts Pregnancy to Early Life Longitudinal Data System (2002-2020).
• This study included 774,092 pregnant women (mean age, 31.2 years; 16.8% Hispanic; 9.3% non-Hispanic Asian/Pacific Islander; 9.5% non-Hispanic Black; and 63.1% non-Hispanic White) who made at least one unscheduled ED visit during pregnancy.
• SMM was assessed in individuals with four or more ED visits during pregnancy and defined as either an ED visit or observational stay during pregnancy not resulting in hospital admission.

TAKEAWAY:

• About 31.3% pregnant individuals made at least one unscheduled ED visit during pregnancy, and 3.3% made at least four ED visits.
• Pregnant individuals with four or more ED visits had a higher risk for SMM than those with no visits (adjusted odds ratio, 1.46; 95% CI, 1.29-1.66); about 43.8% of them visited multiple hospitals during pregnancy.
• ED visits were more common among individuals younger than 20 years (8.7%), Hispanic (5.7%) or non-Hispanic Black (4.9%) individuals, those with public vs private insurance (6.5% vs 1.0%), those with vs without a comorbidity (19.0% vs 2.8%), and those with vs without an opioid use–related hospitalization in the year prior to pregnancy (26.8% vs 3.2%).

IN PRACTICE:

“Despite increased access to and use of scheduled outpatient prenatal care and increasing expenditures on hospital-based obstetric care, inequitable maternal and neonatal outcomes are persistent.To prevent morbidity or worse, we urgently need integrated responses to granular signals of need during the critical period of pregnancy,” the authors wrote.

SOURCE:

The study was led by Eugene R. Declercq, PhD, Boston University School of Public Health, Boston, and was published online on October 16, 2024, in JAMA Network Open.

LIMITATIONS: 

Limitations included the demographic differences between Massachusetts and national birth populations, lack of a standard definition for high emergency care use during pregnancy, inability to track hospital visits outside Massachusetts, and the possibility of missing or unknown influencing factors. Moreover, the dataset did not capture some clinical details from deliveries, and obstetric triage visits could not be identified separately, which may have underestimated emergency care use during pregnancy. Additionally, health system characteristics and small sample sizes for certain analyses may have influenced the findings.

DISCLOSURES:

The study was funded by grants from the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH) and the Health Resources and Services Administration Maternal and Child Health Bureau. Three authors reported receiving grants from the NIH during the study. One author reported receiving personal fees from various sources outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.