Frequent emergency care during pregnancy may indicate a greater risk of serious maternal morbidity

Frequent hospital visits during pregnancy may be a sign that a pregnant woman will face life-threatening complications during or after pregnancy, according to a new study led by Boston University School of Public Health (BUSPH) and Cityblock Health.

Published in JAMA network openedThe study found that of the nearly 775,000 pregnant people in Massachusetts, 31% of these individuals had at least one unplanned emergency hospital visit, and 3.3% had four or more unplanned hospital visits. The latter group was almost 50% more likely to experience severe maternal morbidity (SMM), which includes a range of complications during delivery that can lead to poor maternal outcomes, such as aneurysms, eclampsia, renal and heart failure and sepsis.

Importantly, the findings also showed that nearly half of pregnant people who sought emergency care four or more times during their pregnancy visited multiple hospitals for evaluation. The resulting lack of consistent treatment for patients from any hospital makes it difficult for hospital-based pregnancy programs to identify the true burden of prenatal and postpartum problems experienced by these patients.

The analysis is the first US-based assessment of an association between four or more emergency room visits during pregnancy and the risk of SMM. It builds on one prior study of the researchers, which found that 70% of people who had a pregnancy-related death during the postpartum also visited a hospital between the time of delivery and the time they were hospitalized at death. Because both SMM and maternal mortality rates in the US remain the highest among wealthy countries, identifying these high-risk pregnant patients and understanding the extent of their prenatal health problems could boost efforts to connect this population with other preventive care within their community.

“When there is a bad maternal health outcome, there is a tendency to say, ‘If only we knew earlier,'” said study lead author Dr. Eugene Declercq, professor of community health sciences at BUSPH. “Those in our study who have undergone repeated emergency antenatal visits clearly show us that they are at risk. Avoiding serious maternal morbidity is not something that only happens at the time of birth – it must start with the early identification of cases with high risk, like this one, followed by community-based support to prevent catastrophic outcomes for mothers and babies.”

For the research, Dr. Declercq and his colleagues used data from a statewide database that linked unplanned hospital visits — including trips to the emergency department and observational hospital stays — of 774,092 pregnant patients to births and fetal deaths in Massachusetts between October 2002 and March. 2020.

About 18% of patients had one emergency hospital visit, almost 7% had two visits, 3% had three visits, and 3.3% had four or more visits. About 44% of patients who sought emergency care four or more times during pregnancy visited more than one hospital. This group was 46% more likely to experience SMM than patients who sought less emergency care and visited fewer hospitals during their pregnancy. Patients also sought emergency care more often during the first eight weeks and the last eight weeks of their pregnancy.

The researchers also observed several racial, economic and age-related differences among the patients who used the emergency room multiple times during their pregnancy. The high use of unplanned hospital care was most associated with women under age 25, Hispanic and non-Hispanic black patients, and those who were US-born, unmarried, or who had an additional health condition or opioid-related hospitalization in the year . before their pregnancy. Some of these individuals visited as many as six different hospitals in Massachusetts for emergency care, the researchers say.

“Our research shows for the first time that those who are more likely to visit the emergency room during pregnancy are likely to be people of color who are at significantly greater risk of potentially life-altering illness around childbirth,” study says. senior author Dr. Pooja Mehta, adjunct assistant professor of obstetrics and gynecology at BU’s Chobanian & Avedisian School of Medicine and vice president of population health at Cityblock Health.

“We need to do much more than give these individuals a follow-up prenatal visit; our actions must be timely and address the root causes and fragmentation in the system to impact the layers of structural racism that we already know contribute to maternal mortality. “

The team hopes that these findings will draw attention to the high number of emergency care visits caused by unmet needs – a public health problem that is not well documented – and encourage researchers, health care providers, policy makers and reproductive health advocates to consider ways to reduce strengthen or improve healthcare. compensate for traditional prenatal care that does not meet the health needs of pregnant patients.