Original Research
Obstetrics
Maternal outcomes by race during postpartum readmissions

This study is being presented at the 39th annual meeting of the Society for Maternal-Fetal Medicine, Las Vegas, NV, Feb. 11–16, 2019.
https://doi.org/10.1016/j.ajog.2019.02.016Get rights and content

Background

Maternal race may be an important risk factor for postpartum readmissions and associated adverse outcomes.

Objective

To determine the association of race with serious complications during postpartum readmissions.

Study Design

This repeated cross-sectional analysis used the National (Nationwide) Inpatient Sample from the Healthcare Cost and Utilization Project from 2012 to 2014. Women ages 15–54 readmitted postpartum after a delivery hospitalization were identified by Centers for Disease Control and Prevention criteria. Race and ethnicity were characterized as non-Hispanic white, non-Hispanic black, Hispanic, Asian or Pacific islander, Native American, other, and unknown. Overall risk for readmission by race was determined. Risk for severe maternal morbidity during readmissions by race was analyzed. Individual outcomes including pulmonary edema/acute heart failure and stroke also were analyzed by race. Log-linear regression models including demographics, hospital factors, and comorbid risk were used to analyze risk for severe maternal morbidity during postpartum readmissions.

Results

Of 11.3 million births, 207,730 (1.8%) women admitted postpartum from 2012 to 2014 were analyzed, including 96,670 white, 47,015 black, and 33,410 Hispanic women. Compared with non-Hispanic white women, non-Hispanic black women were at 80% greater risk of postpartum readmission (95% confidence interval, 79%–82%) whereas Hispanic women were at 11% lower risk of readmission (95% confidence interval, 10%–12%). In unadjusted analysis, compared with non-Hispanic white women, non-Hispanic black women admitted postpartum were at 27% greater risk of severe maternal morbidity (95% confidence interval, 24%–30%) whereas Hispanic women were at 10% lower risk (95% confidence interval, 7%–13%). In the adjusted model, non-Hispanic black women were at 16% greater risk for severe maternal morbidity during readmission than non-Hispanic white women (95% confidence interval, 10%–22%), whereas Hispanic women were at 7% lower risk (95% confidence interval, 1%–12%). Differences in severe maternal morbidity risk between other racial groups and non-Hispanic white women were not significant. In addition to overall morbidity, non-Hispanic black women were at significantly greater risk for eclampsia, acute respiratory distress syndrome, and renal failure than other racial groups (P<.05 all). Black women were at 126% greater risk for pulmonary edema/acute heart failure than white women (95% confidence interval, 117%–136%).

Conclusion

Black women were more likely (1) to be readmitted postpartum, (2) to suffer severe maternal morbidity during readmission, and (3) to suffer life threatening complications such as pulmonary edema/acute heart failure. At-risk women including black women with cardiovascular risk factors may benefit from short-term postpartum follow-up.

Section snippets

Materials and Methods

The National (Nationwide) Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project for the years 2012–2014 was used for this repeated cross-sectional analysis. The NIS is a large, publicly available, all-payer inpatient contains a sample of approximately 20% of all hospitalizations in the United States. These hospitalizations are selected via a stratified systemic random sample to generate a population representative of the entire United States across medical specialties that

Results

From 2012 to 2014, an estimated 11.3 million births and 207,730 (1.8%) postpartum readmissions were ascertained from the NIS and included in the analysis. The proportion of non-Hispanic black women readmitted relative to delivery hospitalizations was significantly larger (3.09%; 95% CI, 3.06%–3.12%; n=47,015/1,523,190) than other groups, including non-Hispanic white women (1.71%; 95% 1.70%–1.72%; 96,670/5,650,075), Hispanic women (1.52%; 95% CI, 1.50%–1.54%; 33,410/2,194,500), Asian or Pacific

Main findings

In this analysis of postpartum readmissions, non-Hispanic black women were at significantly greater risk (1) to be readmitted postpartum, (2) to suffer severe maternal morbidity during readmission, and (3) to suffer a range of life-threatening complications. Although non-Hispanic black women were at lower risk for complications such as sepsis, shock, hysterectomy, and transfusion, they were particularly likely to receive a diagnosis of pulmonary edema/acute heart failure, with risk more than

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J.D.W. has served as a consultant for Tesaro and Clovis Oncology. The other authors report no conflict of interest.

A.M.F. is supported by a career development award (K08HD082287) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.

Cite this article as: Aziz A, Gyamfi-Bannerman C, Siddiq Z, et al. Maternal outcomes by race during postpartum readmissions. Am J Obstet Gynecol 2019;220:484.e1-10.

1

These authors contributed equally to this work.

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