Poster Session 1
Emma Trawick Roberts, MD (she/her/hers)
Fellow
University of North Carolina
Chapel Hill, NC, United States
Lauren Kucirka, MD, PhD (she/her/hers)
Assistant Professor
University of North Carolina, Chapel Hill
Chapel Hill, North Carolina, United States
Clara Busse, MPH
Doctoral Student
University of North Carolina, Chapel Hill
Chapel Hill, North Carolina, United States
M. Kathryn Menard, MD, MPH
Distinguished Professor
University of North Carolina, Chapel Hill
Chapel Hill, North Carolina, United States
Catherine Vladutiu, MPH, PhD
Research Associate Professor
University of North Carolina, Chapel HIll
Chapel Hill, North Carolina, United States
We sought to describe those seeking emergency care (EC) in early pregnancy and identify risk factors, including social drivers of health (SDOH), for EC use.
Study Design:
Linked Medicaid hospital claims, live birth records, and North Carolina (N.C.) Pregnancy Medical Home risk screen (https://bit.ly/NCpregriskscreen) data were used to identify risk factors for EC use among 154,353 pregnant Medicaid beneficiaries in N.C. who had a live birth between 1/2014 and 12/2019. EC use included visits to the Emergency Department or obstetric triage unit prior to 20 weeks’ gestation. Demographic characteristics, SDOH, medical co-morbidities, and pregnancy characteristics were compared by the number of EC visits. Among those with ≥1 EC visit, visit diagnoses were assessed by the number of SDOH risk factors. Multivariable ordered logistic regression modeled the association between potential risk factors for EC use and the number of EC visits (0,1,2, ≥3).
Results:
A total of 73,836 women (47.8%) had an EC visit prior to 20 weeks’ gestation; 39,367 had one visit, 18,751 had two, and 15,718 had ≥3 visits. Demographic, SDOH, medical, and pregnancy characteristics by number of EC visits are described in Table 1. Among those with ≥3 SDOH risk factors, 62.4% had an EC visit related to substance use, and 17.5% had a visit related to mental health. In the regression model, selected SDOH, medical comorbidities, and a history of adverse pregnancy outcomes were associated with increased odds of EC use before 20 weeks’ gestation (Table 2). SDOH most associated with increased odds of ED use were physical assault within the last year, food insecurity, unstable living, undesired pregnancy, and substance use among family, friends, or partners.
Conclusion:
Nearly half of pregnancies among Medicaid beneficiaries in NC had ≥1 EC visit prior to 20 weeks’ gestation. Given the association between SDOH and increased odds of EC use, early EC use in pregnancy may signal social vulnerability and opportunity for targeted intervention.
