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Am J Perinatol 2023; 40(04): 348-355
DOI: 10.1055/s-0042-1758485
SMFM Fellowship Series Article

Association of Social Determinants of Health and Clinical Factors with Postpartum Hospital Readmissions among Nulliparous Individuals

Natasha R. Kumar
1   Department of Obstetrics and Gynecology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
2   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
William A. Grobman
2   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
David M. Haas
3   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Robert M. Silver
4   Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
,
Uma M. Reddy
5   Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
,
Hyagriv Simhan
6   Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Deborah A Wing
7   Department of Obstetrics and Gynecology, University of California, Irvine, Orange, California
,
Brian M. Mercer
8   Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Lynn M. Yee
9   Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
› Author Affiliations Funding This work was supported by a National Heart Lung, Blood Institute grant R01HL105549, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): U10 HD063036, RTI International; U10 HD063072, Case Western Reserve University; U10 HD063047, Columbia University; U10 HD063037, Indiana University; U10 HD063041, University of Pittsburgh; U10 HD063020, Northwestern University; U10 HD063046, University of California Irvine; U10 HD063048, University of Pennsylvania; and U10 HD063053, University of Utah, and the U.S. Department of Health and Human Services and the National Institutes of Health.
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Abstract

Objective Prior data suggest that there are racial and ethnic disparities in postpartum readmission among individuals, especially among those with hypertensive disorders of pregnancy. Existing reports commonly lack granular information on social determinants of health. The objective of this study was to investigate factors associated with postpartum readmission for individuals and address whether such risk factors differed by whether an individual had an antecedent diagnosis of a hypertensive disorder of pregnancy (HDP).

Study Design This is a secondary analysis of a large, multicenter prospective cohort study of 10,038 nulliparous participants. The primary outcome of this analysis was postpartum readmission. A priori, participants were analyzed separately based on whether they had HDP. Participant characteristics previously associated with a greater risk of perinatal morbidity or readmission (including social determinants of health, preexisting and chronic comorbidities, and intrapartum characteristics) were compared with bivariable analyses and retained in multivariable models if p < 0.05. Social determinants of health evaluated in this analysis included insurance status, self-identified race and ethnicity (as a proxy for structural racism), income, marital status, primary language, and educational attainment.

Results Of 9,457 participants eligible for inclusion, 1.7% (n = 165) were readmitted following initial hospital discharge. A higher proportion of individuals with HDP were readmitted compared with individuals without HDP (3.4 vs 1.3%, p < 0.001). Among participants without HDP, the only factors associated with postpartum readmission were chorioamnionitis and cesarean delivery. Among participants with HDP, gestational diabetes and postpartum hemorrhage requiring transfusion were associated with postpartum readmission. While the number of postpartum readmissions included in our analysis was relatively small, social determinants of health that we examined were not associated with postpartum readmission for either group.

Conclusion In this diverse cohort of nulliparous pregnant individuals, there was a higher frequency of postpartum readmission among participants with HDP. Preexisting comorbidity and intrapartum complications were associated with postpartum readmission among this population engaged in a longitudinal study.

Key Points

  • Non-HDP patients had higher odds of PPR with chorioamnionitis or cesarean.

  • HDP patients had higher odds of PPR if they had GDM or PPH.

  • Characterizing PPR may identify and highlight modifiable factors.

Keywords

hypertensive disease of pregnancy - postpartum readmission - social determinants of health

Note

This abstract was previously presented at the Society of Maternal Fetal Medicine's 40th Annual Meeting on February 8, 2020, in Grapevine, TX.


Supplementary Material



Publication History

Received: 03 February 2022

Accepted: 14 September 2022

Article published online:
25 November 2022

© 2022. Thieme. All rights reserved.

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