The rate of chronic conditions among the childbearing population increased between 2005-2006 and 2013-2014, particularly among women from rural and low-income areas and those with deliveries funded by Medicaid, according to findings published in The Green Journal.
“During prenatal care, we have the unique opportunity to have frequent contact with a patient throughout her pregnancy and postpartum recovery. Ideally, in addition to addressing obstetric care, we can also use this time to help her optimize her long-term health,” Lindsay Admon, MD, obstetrician and gynecologist at Michigan Medicine, said in a press release. “We wanted to better understand the trends, prevalence and socioeconomic distribution of chronic conditions among women giving birth in the United States to help providers and policymakers better take care of this population.”
Researchers examined 2005-2014 data from the National Inpatient Sample to determine the prevalence and socioeconomic distribution of chronic conditions — including respiratory disease, diabetes, hypertension, heart disease, renal disease, liver disease, HIV and substance abuse disorders — among women hospitalized for delivery in the U.S. In their retrospective, cross-sectional analysis, Admon and colleagues compared differences over time across rural and urban residence, income and payer subgroups for each chronic condition.
The investigators included 8,193,707 delivery hospitalizations, which occurred nationally between 2005 and 2014, in their analysis. They found that detection of at least one chronic condition increased nearly 40% between 2005-2006 and 2013–2014 (66.9 per 1,000 delivery hospitalizations versus 91.8 per 1,000). In addition, prevalence of multiple chronic conditions rose from 4.7 (95% CI 4.2-5.2) to 8.1 (95% CI 7.8-8.4) per 1,000 delivery hospitalizations during the study period.
Notably, substance use disorders were detected at a higher rate among rural women, and all conditions were detected at a higher rate among lowest income communities and those with Medicaid-funded deliveries by 2013-2014.
‘The highest prevalence of chronic conditions tied to maternal morbidity and mortality was identified among already vulnerable populations — those living in rural areas and in the poorest communities,” Admon said. “These findings highlight stark and growing health disparities in maternal health.”
The chronic conditions with the greatest increases in prevalence over time included respiratory disease, hypertension, substance use disorders, and pre-existing diabetes. These increasing disparities over time were seen across all socioeconomic subgroups.
“Historically, the leading causes of maternal morbidity and mortality in the U.S. have been related to delivery, such as infection or hemorrhage. For the first time in our country, we are seeing complications from pre-existing conditions causing the most harm,” Admon said. “As maternal health providers we need to be aware of the increasing burden of chronic conditions complicating our patients’ pregnancies and deliveries. That means actively screening for these conditions and educating our patients about optimal management both during pregnancy and for the long term. – by Savannah Demko
Disclosures: Admon reports no financial disclosures. Please see the study for all other authors’ relevant financial disclosures.