Abstract
Introduction
Research on maternal birth outcomes rarely includes postpartum complications with
longitudinally linked patient data. We analyze characteristics associated with delivery
complications and postpartum hospital use.
Methods
This population-based cohort study is based on administrative data from California.
International Classification of Diseases, 10th Revision, codes were used to categorize the incidence of severe maternal morbidity
and other route-specific delivery complications as well as preexisting and pregnancy-related
conditions and principal diagnoses for postpartum hospital visits. Postpartum hospital
use is a composite outcome defined as emergency department visit or hospital readmission
within 90 days of birth admission discharge. Multivariable modified Poisson regression
analyses were used to estimate the association of patient-level and hospital-level
characteristics with the likelihood of postpartum hospital use.
Results
In 2017, 457,498 birth admissions occurred in California-licensed hospitals, of which
348,828 index births with linked data were analyzed. Among linked births, 34,825 (10.0%)
had an inpatient admission (4,206 [1.2%]) or an emergency department visit (30,371
[9.2%]) within 90 days of birth admission discharge. Birth complications included
a 1.7% severe maternal morbidity rate, 7.9% rate of vaginal birth complications, 10.0%
rate of cesarean birth complications, and 2.9% frequency of long lengths of stay,
all of which were significantly associated with postpartum hospital use. Other significant
risk factors for postpartum hospital use were preexisting and pregnancy-related conditions,
undergoing cesarean birth, being younger than 18 years old, being non-Hispanic Black,
living in a high poverty ZIP code, and having Medicaid.
Conclusion
One in 10 birthing persons had a hospital visit within 90 days postpartum. Improving
postpartum care is an urgent public health priority.
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Biography
Chen Y. Wang, MD, MPH, is a Public Health and General Preventive Medicine Resident at Cook County Health and received a Master of Public Health at Northwestern University Feinberg School of Medicine. She is board-certified in Family Medicine.
Biography
Lynn M. Yee, MD, MPH, is an Assistant Professor in the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine. Her work addresses obstetrics-focused patient-centered outcomes research and implementation science.
Biography
Joseph M. Feinglass, PhD, is a Research Professor of Medicine in the Division of General Internal Medicine and Geriatrics with experience in health policy, quality improvement, health disparities, medical informatics, patient safety, women's health, and social epidemiology research.
Article info
Publication history
Published online: September 24, 2021
Accepted:
August 26,
2021
Received in revised form:
August 4,
2021
Received:
December 8,
2020
Footnotes
Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [5R01 HD098178-02].
The authors have no conflicts of interest to disclose.
Identification
Copyright
© 2021 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
