Severe Maternal Morbidity Among Low-Income Patients with Hypertensive Disorders of Pregnancy

Academic Article


  • OBJECTIVE: Hypertensive disorders of pregnancy (HDP) contribute significantly to the development of severe maternal morbidities (SMM), particularly among low income women. The purpose of the study was to explore the relationship between maternal characteristics and SMM, and to investigate if differences in SMM exist among patients with HDP diagnosis. STUDY DESIGN: This study utilized 2017 Alabama Medicaid administrative claims. SMM diagnoses were captured using the CDC's classification by ICD codes, Maternal characteristics and frequencies were compared using Chi-Square and Cramer's V statistics. Logistic regression analyses were conducted to examine multivariable relationships between maternal characteristics and SMM among patients with HDP diagnosis. Odds ratios and 95% confidence intervals were used to estimate risk. RESULTS: A higher proportion of patients experiencing SMM were >34 years old, Black, Medicaid for low income families (MLIF) eligible, lived in a county with greater Medicaid enrollment, and entered prenatal care (PNC) in the first trimester compared to those without SMM. Almost half of patients (46.2%) with SMM had a HDP diagnosis. After controlling for maternal characteristics, HDP, maternal age, county Medicaid enrollment, and trimester PNC entry were not associated with SMM risk. However, Black patients with HDP were at increased risk for SMM compared to White patients with HDP when other factors were taken into account (aOR=1.37, 95%CI: 1.11-1.69). Patients with HDP and SMM were more likely to have a prenatal hospitalization (aOR=1.45, 95%CI: 1.20-1.76), emergency visit (aOR=1.30, 95%CI: 1.07-1.57), and postpartum cardiovascular prescription (aOR=2.43, 95%CI: 1.95-3.04). CONCLUSION: Rates of SMM differed by age, race, Medicaid income eligibility, and county Medicaid enrollment but were highest among patients with clinical comorbidities, especially hypertensive disorders of pregnancy. However, among patients with HDP, Black patients had an elevated risk of severe morbidity even after controlling for other characteristics.
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  • Moore M; Mazzoni S; Wingate MS; Bronstein J