In a recent study published in the Journal of Women's Health, Baltimore-based Johns Hopkins researchers found Medicaid-insured, low-income women who experienced complications with their pregnancies used the emergency room at higher than average rates after delivery.
The researchers examined Medicaid insurance claims for live birth deliveries between 2003 and 2010, as well as outpatient, inpatient and ER visit claims during pregnancy, six months preconception and 12 months after delivery. They also collected data on patients' age, race and ethnicity, history of cesarean delivery and preconception conditions.
Highlighted below are the researchers' findings.
1. All total, more than 26,000 pregnant women had at least 100 days of continuous Medicaid coverage during pregnancy and at least 90 days of continuous Medicaid coverage postpartum.
2. Roughly 20 percent of the pregnancies were complicated by conditions such as gestational diabetes, gestational hypertension or preeclampsia. About 70 percent of the women had become eligible for Medicaid because of their pregnancy.
3. Although a quarter of all the patients visited the ER within six months of delivery, the women who had experienced one or more of the three pregnancy complications considered for the study were 14 percent more likely to go to the ER than those who hadn't had those complications. Being under 25 years old increased the odds of an ER visit as well, by 20 percent.
4. Sixty percent of the ER visits that occurred among the women with complicated pregnancies were prior to the six-week visit that is frequently recommended, and the visits continued on well after the six-week visit.
5. Other factors that increased the chances that those with complicated pregnancies would visit the ER included having a cesarean delivery (a 24 percent increase) or having any of the identified preconception health issues (a 63 percent increase).
According to the authors of the study, postpartum patients — particularly young, low-income women who experienced complicated pregnancies — may require better hospital discharge plans and earlier postpartum care.
Wendy Bennett, MD, an assistant professor of medicine in the Johns Hopkins University School of Medicine's Division of General Internal Medicine, said one potential intervention might include early postpartum home or community-based visits that address recent pregnancy complications, long-term health behavior changes and social challenges, such as healthcare access and housing.
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