Emergency care use in early pregnancy and adverse maternal events at birth and up to 42 days postpartum among North Carolina Medicaid beneficiaries
Emma Trawick, Lauren M. Kucirka, Mekhala V. Dissanayake, M. Kathryn Menard, Catherine J. VladutiuAbstract
Objective
Emergency care (EC) utilization can indicate unmet medical or social needs. In pregnancy, EC use may identify individuals at risk for adverse outcomes and highlight opportunities for intervention. This study examined the association between EC use in early pregnancy and adverse maternal events.
Study design
We conducted a retrospective cohort study of pregnant Medicaid beneficiaries in North Carolina who had live births between January 2014 and December 2019. We used linked Medicaid hospital claims, birth certificates, and Pregnancy Risk Screening data. EC use included visits to the emergency department or obstetric triage unit prior to 20 weeks’ gestation and was categorized as 0, 1, 2, or ≥ 3 visits. The primary outcome was any adverse maternal event, including severe maternal morbidity or admission to the intensive care unit during birth hospitalization and up to 42 days postpartum. Multivariable modified Poisson regression estimated adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for adverse maternal events by early EC use, adjusting for demographic characteristics, medical comorbidities, and social drivers of health. Secondary analyses examined the association between EC visit diagnoses and adverse maternal events.
Results
Among 132,609 pregnant individuals, 67,973 (51.3%) had at least one EC visit prior to 20 weeks’ gestation. A higher proportion of those with EC use were younger, identified as non‐Hispanic Black, had low educational attainment, and had hypertension, diabetes, asthma, and mental illness. Adverse maternal events occurred in 2356 individuals (1.7%). In adjusted analyses, the risk of adverse maternal events increased with the number of EC visits: one visit (aRR, 1.24; 95% CI, 1.12–1.37), two visits (aRR, 1.67; 95% CI, 1.49–1.88), and ≥3 visits (aRR, 1.99; 95% CI, 1.78–2.23) compared with no visits. In secondary analyses, EC diagnosis codes most strongly associated with adverse maternal events included hypertension, cardiovascular disease, anemia, metabolic disease, and multifetal gestation.
Conclusion
An increasing number of EC visits in early pregnancy was associated with a higher risk of adverse maternal events. These encounters provide a critical early opportunity to identify patients with higher risk for complications, facilitate timely linkage to prenatal care and social support, and implement targeted interventions that may reduce maternal morbidity and mortality.