This study analyzed data from 658 insured pregnant women in a Midwestern county to compare risks and outcomes between those who did and did not utilize the emergency department (ED) during their peripartum period. The study found that 218 women (33%) visited the ED at least once during this time. ED users were more likely to experience psychosocial risks like postpartum depression and smoking, have poorer birth outcomes like prematurity, and have inadequate prenatal care. After adjusting for demographic factors, ED use was associated with a higher likelihood of postpartum depression, smoking during pregnancy, unstable housing, delayed prenatal care initiation, and missing a postpartum visit.

1.  Given the vulnerability of women and infants to
adverse peripartum conditions, federal programs
provide access to prenatal care and social
services, but few studies have examined ED
utilization by this population
Background
Table 2: Adjusted Logistic Regression* (n=658)
ED Use
(n=218)
No ED Use
(n=440)
OR 95% CI
Psychosocial Risk
Postpartum depression 40 20.1%** 29 6.8% 2.9 1.7 – 5.0
Prenatal Smoker 61 28.1%** 36 8.2% 3.0 1.8 – 4.9
Hx Alcohol Problem 6 6.1%** 3 1.5% 3.2 0.7 – 14.5
Hx Drug Problem 7 7.1%** 4 2.0% 2.5 0.6 – 9.4
History of abuse 39 21.9%** 55 15.2% 1.3 0.8 – 2.1
Unstable Housing 34 16.4%** 29 7.2% 2.0 1.2 – 3.6
Birth Outcomes
Low Birth Weight 15 6.9% 16 3.7% 1.4 0.7 – 3.0
Prematurity 20 9.2%** 21 4.8% 1.9 0.9 – 3.7
Primary Care Utilization
Delayed entry into prenatal care 59 27.4%** 59 13.7% 1.6 1.0 – 2.5
Did not attend postpartum visit 24 12.2%** 20 4.7% 2.1 1.1 – 4.0
*Adjusted for adolescence, marital status, race and medical insurance **p<.05 Pearson Chi-Square
 Secondary analysis of data from a Midwestern
 county-wide postpartum depression study
 County residents giving birth Feb-May 2009 were
systematically recruited from postpartum hospital floor.
 670 (74%) of eligible women were enrolled.
 658 Final Sample (12 withdrew from study)
 Trained research assistants (RAs) conducted phone
interviews at 2 months postpartum, collecting
information about psychosocial risk .
 621 (94%) completed the survey.
 RAs, monitored for intercoder reliability, also collected
demographics & pregnancy outcomes.
 ED-visit datasets were produced from hospital
administrative records.
 The peripartum period was defined as 8 weeks gestation
to 4 months postpartum
 Logistic regression, adjusted for demographic factors,
was used to identify the association between
psychosocial risk, birth outcomes, primary care
utilization and ED use.
Methods
 Among participants, 218 (33%) used the ED at
least once and 108 (16%) had more than one ED
visit during their peripartum period.
 49% of ED visits generated by this group were for
non-obstetric illness, 38% for obstetric-postpartum
reasons, 10% for injury and 3% for
substance/mental health concerns.
 ED users were significantly more likely to be
teenagers (14.2% v 6.4%; p=0.001 ), single (58.3%
v 28.7%; p<0.001 ), black (29.4% v 10.7%;
p<0.001 ), and Medicaid-insured (47.7% v 22.0%;
p<0.001 ).
 ED users were significantly more likely to have the
following psychosocial and health risks:
Postpartum depression, prenatal smoking, drug or
alcohol problem, a history of abuse, insecure
housing, obese body mass index (32.4% v 19.9%,
p=.002), inadequate prenatal weight gain (24.7% v
13.7%, p=.002), late entry into prenatal care, and
missed postpartum checkup visit.
Results
 Adjusting for demographic factors, ED users were
more likely to screen positive for postpartum
depression, OR=2.9 (1.7-5.0), to smoke prenatally
OR=3.0 (1.8-4.9), to have unstable housing, OR
2.0 (1.2-3.5), delayed onset into prenatal care, OR
1.6 (1.0-2.5) and fail to attend their postpartum
visit, OR=2.1(1.1-4.0).
Results Cont.
Limitations/Policy Implications
 Among a fully insured sample of pregnant
women, an ED visit was a marker for poor
perinatal outcomes and inadequate primary care
Conclusions
2009 County
Population
(N=2,674)
Study Sample
(658)
p-value
Age
Adolescent (<20)
Not Adolescent (20+)
9.6%
90.4%
9.0%
91.0%
0.6379
Maternal Race
White
Black
Other
76.3%
19.5%
4.2%
78.3%
16.9%
4.9%
0.1277
Marital Status
Married
Single
58.5%
41.5%
61.5%
38.5%
0.1609
Insurance Status
Private
Medicaid
No insurance
51.8%
47.6%
0.6%
67.3%
30.5%
2.1%
<0.0001
Prenatal Care (Kessner)
Adequate
Intermediate
Inadequate
65.9%
26.6%
7.1%
72.3%
22.9%
4.8%
0.0338
Prenatal BMI
Underweight
Healthy weight
Overweight
Obese
3.6%
45.2%
25.3%
25.9%
2.4%
47.9%
25.7%
24.0%
0.1261
Birthweight
Adequate (2500+ grams)
LBW (1501-2499 grams)
VLBW (<1501 grams
92.8%
6.0%
1.1%
95.3%
4.0%
0.8%
0.0216
Prematurity
<37 wks gestation
37-52 wks gestation
8.4%
91.6%
6.2%
93.8%
0.0619
 These findings indicate a need for integrated
psychosocial interventions in the perinatal
period among pregnant ED users
 And an opportunity to link to primary care
Characterizing Emergency Department Utilization
By A Population-based Cohort of Insured Pregnant Women
Karin V. Rhodes, MD, MS¹; Catherine Kothari², Shama Tareen³, Michael Lipman³
¹University of Pennsylvania SOM, Dept of Emergency Medicine ²Western Michigan University SOM, Dept of Emergency Medicine,³Western Michigan University SOM Dept of Psychiatry
 To characterize ED utilization and differences in
risks and outcomes between pregnant women
who use vs. do not use the ED during their
peripartum period.
Objective
Table 1: Study Sample Demographics (n=658)
Figure 1: Edinburgh Postpartum Depression Scores