Factors Associated With Discharge Against Medical Advice in Pregnancy [ID 1600]

INTRODUCTION: Discharge against medical advice (DAMA) is associated with increased morbidity, although this is not well-characterized in pregnancy. We sought to determine the factors associated with DAMA in pregnancy and to establish the rate of adverse pregnancy outcomes. METHODS: We conducted a retrospective cohort study of pregnant patients who underwent DAMA at a tertiary care hospital from March 2018 to March 2019. Demographic data, the reasons for DAMA, and adverse pregnancy outcomes were abstracted from the medical record. Descriptive statistics were used to summarize the data. RESULTS: Our study included 65 pregnant individuals who presented to the hospital and were discharged against medical advice. The majority identified as African American (60.0%), were publicly insured (78.5%), identified as single (64.6%), and were multiparous (70.7%). Almost one-quarter (21.5%) had a mental health condition, and substance use during pregnancy was identified in 32.3% with the most common substance being marijuana (21.5%). The top reasons for DAMA were childcare or caregiving responsibilities (43.1%), elopement (30.8%), and discontent with the plan of care (20.0%). Delivery records were available for 47 individuals. The average gestational age at delivery was 37.6±2.8 weeks of gestation, and the NICU admission rate was 21.2%. 42.6% underwent a cesarean delivery, and 23.4% had a small-for-gestational-age fetus. CONCLUSIONS/IMPLICATIONS: Discharge against medical advice is present in vulnerable populations and associated with adverse pregnancy outcomes. A better understanding of DAMA in pregnancy can help identify key modifiable factors and ultimately result in targeted interventions toward health care equity.