(1205) More frequent emergency care utilization, prior to 20w0d, is associated with higher preterm birth rates

Objective: Frequent emergency care (EC) utilization throughout pregnancy has been associated with adverse pregnancy outcomes, including preterm birth (PTB). Given that it has previously been shown that care coordination of at-risk populations in North Carolina (NC) is associated with a reduced PTB rate, identifying early EC utilization as a risk factor for PTB affords an opportunity for intervention with the potential for introduction of a care coordination program in EC settings. To that end, the objective of this study was to assess whether the frequency of early EC utilization, prior to 20w0d, is associated with higher rates of PTB.

Study Design: Retrospective cohort study of pregnant Medicaid recipients who had a live birth in NC between 01/01/2014–12/31/2019, using linked birth records and NC Medicaid hospital claims. Early pregnancy EC use was defined as an encounter in OB triage or the emergency department prior to 20w0d. We categorized frequency of EC visits before 20w0d as follows: 0, 1, 2, or 3 visits. We built a multivariable modified Poisson regression model to analyze the association between early EC visits and PTB, adjusted for potential confounders.

Results: With increasing EC utilization prior to 20w0d (Table 1), the % of patients with PTB increased. Among those with zero EC visits prior to 20w0d, 0.53% delivered < 28w0d, compared to 0.86%, 1.02%, and 1.43%, in those with 1, 2, and 3 ED visits, respectively. A similar trend was observed among those who delivered between 28w0d-33w6d and between 34w0d-36w6d. In a multivariable model adjusted for confounders, a higher number of early ED visit was associated with an increased risk of PTB < 28 weeks (adjusted relative risk (aRR) =1.35, 95% CI: 1.28-1.42), 28w-33w6d (aRR = 1.18, 95% CI: 1.15-1.20), and >34 weeks (aRR =1.13, 95% CI: 1.11-1.15).

Conclusion: More frequent, early EC utilization is associated with a higher rate of PTB in every gestational age category assessed. Clinically, the study reveals an area of opportunity to initiate a prenatal care coordination plan as an intervention in the EC setting, which may potentially reduce the rate of PTB.