title: Emergency Room Utilization After Medically Complicated Pregnancies: A Medicaid Claims Analysis.
abstract: BACKGROUND
  Women with pregnancy complications benefit from closer monitoring postpartum and beyond. Increased postpartum emergency room (ER) use may indicate unmet need for outpatient obstetrics and primary care. The purpose of this study was to evaluate whether women with pregnancy complications (gestational diabetes [GDM], gestational hypertension, and preeclampsia) have increased ER use in the first 6 months postpartum, compared with women without these complications.
  
  
  METHODS
  We conducted a retrospective population-based cohort study using a 2003-2010 Maryland Medicaid managed care claims data set, linked with U.S. Census data. Data included claims for outpatient and ER visits for women aged 12-45 years who were continuously enrolled in Medicaid for at least 100 days of pregnancy and 90 days postpartum. We used logistic regression to calculate the association between pregnancy complications and having ≥1 ER visit in the 6 months postpartum.
  
  
  RESULTS
  We identified 26,074 pregnancies, of which 20% were complicated by GDM, gestational hypertension, or preeclampsia. Of these complicated pregnancies, 42.1% had GDM, 35.4% had gestational hypertension, and 42.5% had preeclampsia (diagnoses were not mutually exclusive). In the 6 months postpartum, 25% of women had ≥1 ER visits. Of the complicated pregnancy group, 27.7% had ≥1 ER visit, versus 23.6% of the comparison group (p<0.0001). In adjusted analyses, women with a pregnancy complication were more likely to have ≥1 ER visit compared with women without these complications (odds ratio [OR]1.14, 95% confidence interval [CI] 1.05-1.23). The strength of association was highest in women under age 25 (OR 1.20, 95% CI 1.09-1.33). Preconception medical comorbidities (type 2 diabetes, chronic hypertension, obesity, asthma, mental health, and substance abuse diagnoses) were also strongly associated with postpartum ER use (OR 1.61, 95% CI 1.51-1.73).
  
  
  CONCLUSIONS
  Pregnancy complications increased ER utilization during the 6 months postpartum, especially among women under age 25 years. Interventions that improve discharge planning and early postpartum care may decrease ER use.
authors.affiliation: 1 Division of General Internal Medicine, The Johns Hopkins University School of Medicine , Baltimore, Maryland.|2 Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University , Baltimore, Maryland.
authors.forename: Ashley
authors.initials: A
authors.lastname: Harris
authors.affiliation: 3 Departments of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore , Maryland.
authors.forename: Hsien-Yen
authors.initials: HY
authors.lastname: Chang
authors.affiliation: 4 Research and Methodology Directorate, Center for Survey Measurement, United States Census Bureau , Washington, DC.|5 Johns Hopkins HealthCare, LLC , Glen Burnie, Maryland.
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.affiliation: 2 Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University , Baltimore, Maryland.|5 Johns Hopkins HealthCare, LLC , Glen Burnie, Maryland.|6 Johns Hopkins School of Nursing , Baltimore Maryland.
authors.forename: Martha
authors.initials: M
authors.lastname: Sylvia
authors.affiliation: 7 Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Donna
authors.initials: D
authors.lastname: Neale
authors.affiliation: 1 Division of General Internal Medicine, The Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Levine
authors.affiliation: 1 Division of General Internal Medicine, The Johns Hopkins University School of Medicine , Baltimore, Maryland.|2 Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University , Baltimore, Maryland.|8 Department of Population, Family and Reproductive Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore , Maryland.
authors.forename: Wendy
authors.initials: W
authors.lastname: Bennett
mesh_terms: D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D016015:Logistic Models; D008396:Maryland; D008484:Medicaid; D016017:Odds Ratio; D011159:Population Surveillance; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications; D012189:Retrospective Studies; D014481:United States