Risk Factors and Impacts of Unplanned Out‐of‐Hospital Births in an Urban Setting

ABSTRACT Background Prior studies have shown that unplanned out‐of‐hospital births (UOHB) are associated with certain maternal risk factors, increased neonatal mortality and poor neonatal outcomes. Objectives To determine the factors that influence the incidence and effects of newborn outcome associated with UOHB in an urban setting. Methods This case‐control study was conducted at University Hospital in Newark, New Jersey using retroactively sampled patient data from January 2017 to December 2022. After quality control, 66 unplanned out‐of‐hospital live singleton births and 72 in‐hospital live singleton births were stratified into maternal and neonatal cases and studied independently. Standard statistical tests, odds ratios and 95% confidence intervals were applied in comparing the in‐hospital birth groups with the UOHB groups. Results In the maternal analysis, Black/African American race (OR = 4.29, 95% CI 2.10, 8.74), English language (OR = 4.13, 95% CI 1.99, 8.59), substance use history (OR = 7.98, 95% CI 2.22, 28.7), having a primary care provider on file (OR = 2.74, 95% CI 1.36, 5.53), absent prenatal care (OR = 5.44, 95% CI 1.71, 17.3) were significantly associated with UOHB. In the newborn analysis, low‐birth‐weight (OR = 5.90, 95% CI 1.87, 18.6), preterm birth (OR = 4.84, 95% CI 1.67, 14.1), hypoglycemia (OR = 38.0, 95% CI 4.95, 291), hypothermia (OR = 35.5, 95% CI 4.62, 272) and bradycardia (OR = 15.58, 95% CI 0.86, 282) were significantly associated with UOHB. Conclusions Newborns of UOHB are more likely to be affected by low‐birth‐weight, preterm birth, hypoglycemia, hypothermia and bradycardia. Consistent with findings from previous studies, in an urban setting, substance use history and absent prenatal care are among the most important predictors for UOHB.