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Post-partum Visits to EDs Increasing for Young Medicaid Patients with Complicated Pregnancies

BALTIMORE – Your emergency department likely is seeing a lot of post-partum patients who had complicated pregnancies, and a new study suggests the reasons why.

The study, which appeared recently in the Journal of Women's Health, finds that Medicaid-insured, low-income women with gestational diabetes, gestational hypertension or preeclampsia during their pregnancies were significantly more likely to have an ED visit in the six months following birth than those without such complications.

For the study, researchers from Johns Hopkins School of Medicine analyzed more than 26,000 Maryland Medicaid claims, finding that beneficiaries with recent complications during their pregnancies used the ED at higher rates after delivery. The reason? They might not be getting the postpartum care and follow-up they need to prevent further health problems, according to the authors.

The issue was especially acute with young mothers under 25 years of age who had pregnancy complications. Furthermore, the study notes, most of the visits for emergency care occurred before the recommended 6-week postpartum appointment, indicating the need for earlier postpartum follow-up for women who suffered pregnancy complications.

"Our results offer clues to opportunities to improve the postpartum and longer-term health of many low-income women," said lead author Ashley Harris, MD, MHS. "Further study might lead to interventions and programs that target these women for intensive discharge planning and follow-up care that could improve access to care and prevent ER use.”

As with most insurance, Medicaid covers a postpartum visit six weeks after childbirth, offering an opportunity to address health conditions that arose or worsened during pregnancy, according to Harris. She explained that many women on Medicaid often miss the visits for a variety of reasons, including lack of childcare and too little understanding about the long-term health risks associated with pregnancy complications. Instead, many patients turn to the ED for care, she added.

For the study, the researchers analyzed the claims database for one of the seven Medicaid managed care programs in Maryland. Data was available on every live birth delivery between 2003 and 2010, as well as outpatient, inpatient and ED visit claims during pregnancy, six months preconception and 12 months after delivery. The study also included information on patient age, race/ethnicity, history of Cesarean delivery, and preconception conditions including type 2 diabetes, chronic high blood pressure, obesity, asthma, mental health issues and substance abuse.

Of the 26,047 pregnant women who had at least 100 days of continuous Medicaid coverage during pregnancy and at least 90 days of continuous Medicaid coverage postpartum, about 20% of the pregnancies were complicated by gestational diabetes, gestational hypertension or preeclampsia.

About a quarter of the patients – 70% of whom had become eligible for Medicaid because of their pregnancy – visited an ED within six months of delivery. Women who had one of the three pregnancy complications, however, were 14% more likely to seek emergency care than those without the complications. Further increasing the odds of an ED visit were being under age 25, having a Cesarean delivery or having certain pre-conception health issues.

Interestingly, the analysis also indicates that 60% of the ED visits occurred prior to the commonly recommended six-week visit, although they often continued after.

Study authors call for better hospital discharge planning and earlier postpartum care, adding that issues covered at the six-week visit with the obstetrician might not be enough to address the issues particular to a population with a high rate of pregnancy complications.

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