Poster Session 1
Jacqueline M. Powell, MD (she/her/hers)
University of Wisconsin School of Medicine and Public Health
Madison, WI, United States
Janine S. Rhoades, MD
Assistant Professor
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States
Ronald E. Gangnon, PhD
University of Wisconsin Department of Population Health Sciences
Madison, Wisconsin, United States
Kara K. Hoppe, DO, PhD (she/her/hers)
Associate Professor
University of Wisconsin School of Medicine and Public Health
Madison, Wisconsin, United States
Access to obstetrical care is of concern to millions of women, especially those living in rural areas, which is estimated to be 49% of Wisconsin females. National emergencies have a disproportionate impact on rural areas especially when access to tertiary care centers is limited. The aim of this study is to examine the effect of the COVID-19 pandemic on the rate of severe maternal morbidity (SMM) across Wisconsin (WI) based on geographic location.
Study Design:
A retrospective cohort study of all births in Wisconsin from March 1, 2017 to March 31, 2023 was constructed using Wisconsin Hospital Association coding data. The pre COVID-19 pandemic was defined as March 1, 2017 – February 29, 2020, and the COVID-19 pandemic was defined as March 1, 2020 to March 31, 2023. Generalized additive logistic regression models were constructed for the change in the SMM rate as a function of geographic location (ZIP code). Statistical analyses were performed using the mgcv package in R.
Results:
There were 334,366 births in WI during the study period – 172,737 pre pandemic and 161,629 during the pandemic. There were 17,598 SMM events (5.3%) during the study period – 9,173 (5.3%) pre pandemic and 8,425 (5.2%) during the pandemic (RR 0.98, 95% CI 0.96-1.01, p=0.28). There was very strong evidence (p < 0.0001) of geographic variation in the impact of the pandemic on the rate of SMM. There were nominally significant (p < 0.05) elevations in the SMM rate for 33 ZIP codes in north central WI and nominally significant reductions in the SMM rate for 75 ZIP codes in south central and northwest WI.
Conclusion:
North central WI, a rural area with fewer hospitals compared to urban areas, had increased rates of SMM during COVID-19. Rural areas are known to have worse health outcomes and these data show that the obstetric population is no exception. When access to tertiary care centers is limited, novel ways to increase access to critical care services for obstetric population needs to be developed to optimize perinatal outcomes.
