Emergency care use in early pregnancy among North Carolina Medicaid beneficiaries

Abstract Objective We sought to describe characteristics of pregnant Medicaid beneficiaries seeking emergency care in early pregnancy and to identify risk factors, specifically social drivers of health (SDOH), for emergency care use. Study design Linked Medicaid hospital claims, live birth records, and North Carolina Pregnancy Risk Screening Form data were used to identify risk factors for emergency care use among pregnancies resulting in a live birth between January 2014 and December 2019. Emergency care use included visits to the emergency department or obstetric triage unit that occurred in pregnancy prior to 20 weeks’ gestation. Demographic characteristics, SDOH, medical comorbidities, and pregnancy characteristics were assessed by the number of emergency care visits that occurred <20 weeks’ gestation. Multivariable ordered logistic regression modeled the association between potential SDOH risk factors for emergency care use and the number of emergency care visits (0, 1, 2, ≥3), adjusting for age, medical comorbidities, and pregnancy characteristics. Models were expressed as odds ratio (OR) with 95% confidence intervals (CI). Results A total of 70,669 (50.4%) pregnancies among North Carolina Medicaid beneficiaries had at least one emergency care visit prior to 20 weeks’ gestation; 36,327 (51.4%) had only 1 emergency care visit, 18,078 (25.6%) had 2 emergency care visits, and 16,264 (23.0%) had ≥3 emergency care visits. Compared to those with no emergency care use, those with any emergency care use prior to 20 weeks’ gestation more frequently identified as Black, were ≤35 years old, experienced physical violence or intimate partner violence within the past year, reported unstable living, food insecurity, and had a parent, friend, or partner with substance use disorder. In multivariable models, several SDOH were associated with increased odds of emergency care use before 20 weeks’ gestation, including having a high school education or less (OR, 1.23; 95% CI, 1.18–1.29), experience of physical violence within the last year (OR, 1.54; 95% CI, 1.45–1.64), food insecurity (OR, 1.20; 95% CI, 1.13–1.26), and housing instability (OR, 1.25; 95% CI, 1.17–1.34). Conclusion Half of pregnant Medicaid beneficiaries in North Carolina had ≥1 emergency care visit prior to 20 weeks’ gestation. Given the association between several SDOH and increased odds of emergency care use, early emergency care use in pregnancy may signal social and economic needs and opportunities for targeted intervention.