A recent study has discovered that among nearly 775,000 pregnant individuals in Massachusetts, 31% had at least one unplanned emergency hospital visit, while 3.3% experienced four or more emergency visits. Those with multiple visits were found to be 46% more likely to face severe maternal morbidity compared to those who sought emergency care less frequently.
The findings suggest that frequent hospital visits during pregnancy could indicate a potential risk of serious complications, according to research conducted by Boston University School of Public Health (BUSPH) in collaboration with Cityblock Health.
Published in JAMA Network Open, the study examined the records of nearly 775,000 pregnant individuals in Massachusetts, discovering that 31% made at least one unplanned emergency hospital visit, with 3.3% visiting the hospital four times or more. This latter group had a nearly 50% higher likelihood of experiencing severe maternal morbidity (SMM), which includes complications during labor or delivery that could lead to poor outcomes like aneurysms, eclampsia, kidney and heart failure, and sepsis.
Significantly, the study also noted that almost half of those who sought emergency care four or more times went to multiple hospitals. This inconsistency in care hampers hospital-based pregnancy programs from fully understanding the challenges pregnant patients face before and after childbirth.
This analysis marks the first assessment in the US linking multiple emergency visits during pregnancy to a heightened risk of SMM. It builds on previous research indicating that 70% of individuals who experienced pregnancy-associated deaths during the postpartum period had visited a hospital between giving birth and their eventual hospitalization. As SMM and maternal morbidity rates in the US remain alarmingly high compared to other affluent nations, recognizing high-risk pregnant patients and understanding their prenatal health issues is vital for connecting them to necessary preventive care.
Dr. Eugene Declercq, the study’s lead author and professor of community health sciences at BUSPH, stated, “When poor maternal health outcomes occur, there’s often a sentiment of wishing we had known sooner. Those in our study with repeated emergency visits clearly highlight their risk factors. Preventing severe maternal morbidity isn’t solely a birth-time issue; it begins with the early identification of high-risk cases and is followed by community support to mitigate severe consequences for both mothers and infants.”
In their research, Dr. Declercq and colleagues utilized data from a statewide database that connected unscheduled hospital visits — including emergency department visits and observational stays — by 774,092 pregnant patients, covering births and fetal deaths in Massachusetts from October 2002 to March 2020.
About 18% of the patients made one emergency visit to the hospital, nearly 7% had two visits, 3% had three visits, and 3.3% had four or more visits. Roughly 44% of those who sought emergency care four or more times visited multiple hospitals. This group was found to be 46% more likely to face SMM compared to patients who had fewer emergency visits and saw less diverse hospital care during their pregnancy. Additionally, patients tended to seek emergency services more during the first and last eight weeks of their pregnancy.
The researchers identified various racial, economic, and age-related disparities among those who repeatedly used emergency care during pregnancy. A higher frequency of emergency room visits was particularly noted among women under 25, Hispanic and non-Hispanic Black patients, as well as those born in the US, unmarried, or with pre-existing health issues or opioid-related hospitalizations in the previous year. Some individuals reported visiting as many as six different hospitals for emergency care in Massachusetts.
Dr. Pooja Mehta, the study’s senior author and adjunct assistant professor of obstetrics & gynecology at BU’s Chobanian & Avedisian School of Medicine, emphasized, “Our study reveals for the first time that individuals who frequently utilize emergency rooms during pregnancy are often people of color, facing significantly increased risks of serious health issues at childbirth. Addressing this requires more than just a follow-up prenatal appointment; we need timely interventions that tackle the fundamental issues and fragmentation within the healthcare system, addressing the impacts of structural racism known to contribute to maternal morbidity.”
The research team hopes these findings will shine a light on the high rates of emergency visits linked to unaddressed needs — a public health concern that has not been sufficiently documented — and inspire efforts among researchers, healthcare professionals, policymakers, and advocates for reproductive health to rethink and enhance traditional prenatal care methods that are often inadequate for meeting the health needs of pregnant patients.
