Association between pre-delivery anemia and postpartum acute care utilization - North Carolina, 2018-2021

One third of pregnancy-associated deaths occur more than one week after delivery; markers for risk stratification are needed. We evaluated whether pre-delivery hemoglobin (HGB) during L&D admission was associated with postpartum acute care utilization (ACU), as an indicator of severe postpartum complications. We conducted a retrospective cohort study of patients who gave birth at gestational age > 23 weeks between January 1, 2018 and June 30, 2021 at a southeastern quaternary care hospital. All data were extracted from electronic health records. Exposure was defined as lowest pre-delivery HGB during the delivery admission, categorized as < 9, 9-< 10, 10-< 11, 11-< 12 and 12+ g/dL. ACU was defined as visit to OB triage, emergency department or inpatient admission within 90 days of delivery. Because 868 patients had multiple pregnancies in the study period, we used generalized estimating equations to quantify the association between pre-delivery HGB and ACU. We created a crude model to estimate total effect of HGB, and an adjusted model including covariates independently associated with anemia in pregnancy and with ACU. Among 8,677 pregnancies, 1,467 (16.9%) utilized acute care in the 90 days postpartum. In crude models, those in HGB categories below 12+ had higher odds of ACU compared to those whose HGB did not drop below 12 (Table 2). After adjusting for potential confounders, this association remained significant among those with a minimum HGB of < 9 (OR: 1.86, 95% CI: 1.26–2.74) and 10-< 11 (OR: 1.30, 95% CI: 1.10–1.54). Low pre-delivery HGB is associated with increased postpartum ACU. This may be a marker for issues that impact prenatal and postpartum health, including nutrition and access to quality preventive healthcare. Low pre-delivery HGB could signal to providers that additional follow up and improved patient-provider communication may be warranted to identify and address underlying health issues. Patients with anemia may benefit from tailored healthcare services and pathways for risk-appropriate, coordinated care throughout the postpartum period.View Large Image Figure ViewerDownload Hi-res image Download (PPT)