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Am J Perinatol 2024; 41(S 01): e563-e572
DOI: 10.1055/a-1925-9972
Original Article

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

Matthew D. Moore 
1   Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
,
Sara E. Mazzoni   *
2   Department of Obstetrics and Gynecology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
,
Martha S. Wingate
1   Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
,
Janet M. Bronstein
1   Department of Health Policy and Organization, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Funding This study was supported by DHHS, HRSA, MCHB grant no.: T76MC00008, NIH, and NCATS grant no.: TL1 TR 003106.
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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

  • Patients with SMM were more likely to have a HDP diagnosis.

  • Among those with HDP, Black patients had elevated risk of SMM.

  • Differences in care delivery did not explain SMM disparities.

Keywords

disparities - hypertensive disorders of pregnancy - maternal - Medicaid - perinatal health - severe maternal morbidity

* Present address: University of Washington School of Medicine, Department of Obstetrics and Gynecology, 325 Ninth Avenue Box 359865, Seattle, WA 98104.




Publication History

Received: 14 June 2021

Accepted: 11 August 2022

Accepted Manuscript online:
17 August 2022

Article published online:
30 December 2022

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