title: Abuse and psychosocial stress as factors in high utilization of medical services during pregnancy.
abstract: High utilization of medical services during pregnancy has not been described as most studies have focused on women who receive inadequate or no prenatal care. This paper describes the characteristics and medical utilization data of 500 pregnant women enrolled in a prospective study. High utilizers (HU), who had a mean of 7.8 utilizations (SD = 3.2), were significantly more likely to be nonwhite, low income, and younger than low utilizers (LU) who had a mean of 0.99 utilizations (SD = 1.1). HU reported a 32% rate of recent abuse compared to 9% for LU. HU also reported significantly more stress, lower self-esteem, and more ambivalence about the pregnancy. Consistent with their higher utilization, they were more likely to be diagnosed with preterm labor, hyperemesis, and gestational diabetes. HU had a higher proportion of complaints of nausea, vomiting, diarrhea, and pain and more mental health diagnoses than LU. Overall, HU were a vulnerable group characterized by recent abuse, economic disadvantage, psychosocial stress, and mental health issues. Their high utilization of medical services may have been due in large part to unmet psychosocial needs.
authors.affiliation: Oregon Health & Science University, Portland, Oregon, USA. bloomt@ohsu.edu
authors.forename: Tina
authors.initials: T
authors.lastname: Bloom
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Curry
authors.forename: Laurel
authors.initials: L
authors.lastname: Durham
mesh_terms: D000328:Adult; D019090:Case Management / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D009729:Nursing / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D011584:Psychology; D012649:Self Concept; D013315:Stress, Psychological / Q000453:epidemiology* / Q000523:psychology*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation*; D014932:Women's Health Services / Q000706:statistics & numerical data*