Rose Kleiman
September 13, 2017
Despite recent efforts to push engagement with primary care and the health system, pregnant women still find themselves seeking emergency department (ED) care[i].
A recent study published in Academic Emergency Medicine sought to better understand the association between maternal comorbidities and ED use. The research team focused on the following comorbidities common in pregnancy: hypertension (pre-eclampsia and eclampsia), diabetes, gestational diabetes, obesity and asthma. The study limited their focus to women between the ages of 18 and 44 who were commercially insured during the pregnancy and up to 6 months afterward. Their analyses control for a known increased use of the ED among rural patients and tries to take into account patient demographics (such as race, ethnicity, income) by controlling for variation in use of the ED by zip code.
The study found that 20% of the women had one or more ED visit and that among those who had used the ED, almost 30 percent (20%) had two or more visits, and over 10 percent (11%) had three or more visits. The mean number of ED visits among pregnant women who received emergency care was 1.52 visits. Even though many sought ED care, only 0.4% of the visits resulted in a hospital admission.
The research team also found that those who sought out any ED care were significantly more likely to have one or more comorbid condition (30 percent vs. 21 percent). All of the comorbid conditions that the group identified as common pregnancy related comorbidities were associated with increased odds of seeking emergency care. Asthma in particular increased the likelihood of a woman receiving emergency care by 2.5 times, which is consistent with other studies of conditions that drive ED use. Table 1 (below) summarizes which patient characteristics lead to increased likelihood of an ED visit.
Table 1. Adjusted Parameter Estimates for Any Prenatal ED Visit
One limitation of this study is that it focused solely on commercially-insured women. It would be interesting to look at ED use among publically-insured women, who may not have the same routine prenatal care that commercially insured women do. Some studies have shown that almost 50% of low-income pregnant women receive emergency care at least once during their pregnancy[ii]. Thus it will be important to look at use of the ED in populations of women who are not commercially insured and try to further study if there are predictors that can be used to help identify potential pregnant frequent ED users.
This study shows that insurance coverage alone does not sufficiently meet the care needs of pregnant women, specifically those with comorbid conditions. A lot of work in healthcare delivery and policy reform has been focused on alternative models of care to keep people out of the ED and increase access to alternative sites. Pregnant women are a population who might benefit from models of care that focus on extended office hours and more involved case management.
[i] Cunningham, S. D., Magriples, U., Thomas, J. L., Kozhimannil, K. B., Herrera, C., Barrette, E., ... & Ickovics, J. R. (2017). Association between Maternal Comorbidities and Emergency Department Use among a National Sample of Commercially‐insured Pregnant Women. Academic Emergency Medicine.
[ii] Magriples U, Kershaw TS, Rising SS, Massey Z, Ickovics JR. Prenatal health care beyond the obstetrics service: utilization and predictors of unscheduled care. Am J Obstet Gynecol 2008;
Rose Kleiman is a medical student at the GW School of Medicine & Health Sciences
