Abstract
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 Centers for Disease Control and Prevention's classification by
International Classification of Diseases 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
(CIs) were used to estimate risk.
Results A higher proportion of patients experiencing SMM were >34 years old, Black, Medicaid
for Low-Income Families eligible, lived in a county with greater Medicaid enrollment,
and entered prenatal care (PNC) in the first trimester compared with 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 with White patients with HDP when other factors
were taken into account (adjusted odds ratio [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
HDP. However, among patients with HDP, Black patients had an elevated risk of severe
morbidity even after controlling for other characteristics.
Key Points
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Patients with SMM were more likely to have a HDP diagnosis.
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Among those with HDP, Black patients had elevated risk of SMM.
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Differences in care delivery did not explain SMM disparities.
Keywords
disparities - hypertensive disorders of pregnancy - maternal - Medicaid - perinatal
health - severe maternal morbidity
