Hemoglobin on admission for childbirth and postpartum acute care use in a southeastern healthcare system
Katharine E. Bruce, Clara E. Busse, Kristin Tully, Emily S. Patterson, Alison Stuebe- Obstetrics and Gynecology
- Pediatrics, Perinatology and Child Health
Background: Assessment of perinatal risk among birthing people is often based on preexisting comorbidities, which may miss patients with limited preventive healthcare. Additional tools are needed to improve perinatal risk assessment during the childbirth hospitalization. Objective: To evaluate whether hemoglobin on admission for childbirth is associated with postpartum acute care use. Study Design: We conducted a retrospective cohort study of patients giving birth at a southeastern quaternary care hospital from January 2018 through June 2021 using electronic health records. Pre-delivery hemoglobin was categorized as <9, 9-<10, 10-<11, 11-<12 and ≥12 g/dL. Acute care was defined as a visit to obstetric triage, the emergency department or inpatient admission within 90 days postpartum. Generalized estimating equations quantified the crude and multivariable-adjusted association between pre-delivery hemoglobin and acute care use. Results: Among 8,677 pregnancies, 1,467 (16.9%) used acute care in the system within 90 days postpartum. In unadjusted models, those with pre-delivery hemoglobin <9 had twice the risk of postpartum acute care use compared to those with hemoglobin ≥12 (95% Confidence Interval (CI): 1.59-2.69), with a decrease in risk for each increase in hemoglobin category (9-<10g/dL: Risk Ratio (RR): 1.47, CI: 1.21-1.79; 10-<11g/dL: RR: 1.44, CI: 1.26-1.64; 11-<12g/dL: RR: 1.20, CI: 1.07-1.34). The adjusted model showed a similar trend with smaller effect estimates (<9g/dL: RR: 1.56, CI: 1.10-2.21; 9-<10g/dL: RR: 1.15, CI: 0.90-1.47; 10-<11g/dL: RR: 1.24, CI: 1.06-1.45; 11-<12g/dL: RR: 1.11, CI: 0.98-1.27). Conclusion: Low hemoglobin at childbirth admission was associated with increased postpartum acute care use. Low hemoglobin on admission could signal to providers that additional follow up, resources, and ongoing support are warranted to identify and address underlying health needs. Because hemoglobin is routinely assessed during the childbirth hospitalization, this indicator may be especially valuable for risk assessment among patients with limited prior engagement in healthcare.