Association between Maternal Comorbidities and Emergency Department Use among a National Sample of Commercially-insured Pregnant Women

Abstract

Objectives

Evidence suggests that, despite routine engagement with the health system, pregnant women commonly seek emergency care. The objectives of this study were to examine the association between maternal comorbidities and emergency department use among a national sample of commercially-insured pregnant women.

Methods

We conducted a retrospective cohort study using multi-payer medical claims data maintained by the Health Care Cost Institute for women ages 18-44 years with a live singleton birth in 2011 (N=157,786). The association between common maternal comorbidities (e.g., hypertension, gestational diabetes) and emergency department use during pregnancy was examined using multilevel models, while controlling for age, region, and residential ZIP code.

Results

Twenty percent (n=31,413) of pregnant women had ≥1 emergency department visit, (mean=1.52, SD=1.15). Among those who used the emergency department, 29% had ≥2 visits, and 11% had ≥3 visits. Emergency care seekers were significantly more likely to have ≥1 comorbid condition compared to those with no emergency care: 30% versus 21%, respectively (p<0.001). Pregnant women with asthma had 2.5 times the likelihood of having had any emergency department visit (adjusted odds ratio [AOR]=2.46, 95% confidence interval [CI] 2.32-2.62). There was a significant increase in the probability (approximately 50%) of emergency department use among pregnant women with diabetes (AOR=1.47, CI 1.33-1.63), hypertension (AOR=1.49, CI 1.43-1.55), or who were obese (AOR=1.55, CI 1.47-1.64). Increased odds associated with gestational diabetes was more modest, resulting in a 13% increased odds of using the emergency department (AOR=1.13, CI 1.07-1.18). Less than 0.6% of pregnant women (n=177) received emergency care that resulted in a hospital admission. The admission rate was 0.4% (189 admissions/47,608 emergency department visits).

Conclusions

Among pregnant women, comorbidity burden was associated with more emergency department utilization. Efforts to reduce acute unscheduled care and improve care coordination during pregnancy should target interventions to patient comorbidity.

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