Maternal Emergency Department Use Before Pregnancy and Infant Emergency Department Use After Birth

Abstract

ImportanceMaternal emergency department (ED) use before or during pregnancy is associated with worse obstetrical outcomes, for reasons including preexisting medical conditions and challenges in accessing health care. It is not known whether maternal prepregnancy ED use is associated with higher use of the ED by their infant.ObjectiveTo study the association between maternal prepregnancy ED use and risk of infant ED use in the first year of life.Design, Setting, and ParticipantsThis population-based cohort study included all singleton livebirths in all of Ontario, Canada, from June 2003 to January 2020.ExposuresAny maternal ED encounter within 90 days preceding the start of the index pregnancy.Main Outcomes and MeasuresAny infant ED visit up to 365 days after the index birth hospitalization discharge date. Relative risks (RR) and absolute risk differences (ARD) were adjusted for maternal age, income, rural residence, immigrant status, parity, having a primary care clinician, and number of prepregnancy comorbidities.ResultsThere were 2 088 111 singleton livebirths; the mean (SD) maternal age was 29.5 (5.4) years, 208 356 (10.0%) were rural dwelling, and 487 773 (23.4%) had 3 or more comorbidities. Among singleton livebirths, 206 539 mothers (9.9%) had an ED visit within 90 days before the index pregnancy. ED use in the first year of life was higher among infants whose mother had visited the ED before pregnancy (570 per 1000) vs those whose mother had not (388 per 1000) (RR, 1.19 [95% CI, 1.18-1.20]; ARD, 91.1 per 1000 [95% CI, 88.6-93.6 per 1000]). Compared with mothers without a prepregnancy ED visit, the RR of infant ED use in the first year was 1.19 (95% CI, 1.18-1.20) if its mother had 1 prepregnancy ED visit, 1.18 (95% CI, 1.17-1.20) following 2 visits, and 1.22 (95% CI, 1.20-1.23) after at least 3 maternal visits. A low-acuity maternal prepregnancy ED visit was associated with an adjusted odds ratio (aOR) of 5.52 (95% CI, 5.16-5.90) for a low-acuity infant ED visit, which was numerically higher than the pairing of a high-acuity ED use between mother and infant (aOR, 1.43, 95% CI, 1.38-1.49).Conclusions and RelevanceIn this cohort study of singleton livebirths, prepregnancy maternal ED use was associated with a higher rate of ED use by the infant in the first year of life, especially for low-acuity ED use. This study’s results may suggest a useful trigger for health system interventions aimed at reducing some ED use in infancy.

Recent Immigrants With Inflammatory Bowel Disease Have Significant Healthcare Utilization From Preconception to Postpartum: A Population Cohort Study

“…Possibly, similar reasons are leading to our observations in IBD, particularly as healthcare utilization in the remote immigrant group was similar to the non-immigrant group suggesting acculturation (35). Nonetheless, observed disparities in healthcare utilization in immigrant groups during pregnancy remains alarming because it may suggest poor ambulatory gastroenterology and prenatal care access (15,36), which in turn may result in poor outcomes such as preterm birth and neonatal death (10,16–18).…”

“…These issues may be further amplified during pregnancy because of heightened provider and patient concerns (9,10). Previous studies have demonstrated that, compared with non-immigrant women, immigrant women are less likely to receive adequate prenatal care, which in turn increases the risk of adverse pregnancy outcomes, such as preterm delivery and low birth weight (LBW) (11)(12)(13)(14).…”

“…Previous studies have demonstrated that, compared with non-immigrant women, immigrant women are less likely to receive adequate prenatal care, which in turn increases the risk of adverse pregnancy outcomes, such as preterm delivery and low birth weight (LBW) (11)(12)(13)(14). Furthermore, increased acute healthcare utilization during pregnancy may reflect poor access to specialist care (15) and increased maternal comorbidity (10,(16)(17)(18) and result in even higher risks of these adverse pregnancy outcomes (16). Whether this applies to women with IBD has not been previously explored but remains critical to understand to optimize pregnancy outcomes for both the mother and the baby.…”

Factors associated with non‐urgent presentations in the paediatric emergency department using Andersen's behavioural model: A cross‐sectional descriptive study

“…Secondly, in terms of predisposing factors, we found that there was an inverse association between paediatric patients brought in by their fathers and NUPs. On the one hand, this may be due to the fact that mothers tend to be the PC givers and therefore attend PEDs more often than fathers (Varner et al., 2023). On the other hand, the higher levels of psychological distress reported by mothers compared to fathers during visits to the PED may provide an alternative explanation (Montoro‐Pérez et al., 2020).…”

Equity in prenatal healthcare services globally: an umbrella review

“…Evidence suggests that suboptimal health outcomes during this life-stage stem from inequitable access to and subsequent engagement in prenatal care services [ 8 , 9 ]. Studies have identified that inadequate prenatal care can result in a higher risk of complications during and after pregnancy for the birthing individual and infant [ 10 – 16 ]. Our review focuses on the prenatal period as adequacy of care during this time can influence subsequent physiological and psychological experiences during birth and the postpartum period [ 10 – 17 ].…”