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Topics
- Access to Care (2)
- Adverse Drug Events (ADE) (1)
- Adverse Events (3)
- Antibiotics (1)
- Children/Adolescents (1)
- Comparative Effectiveness (2)
- COVID-19 (1)
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- Healthcare Cost and Utilization Project (HCUP) (3)
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- (-) Labor and Delivery (21)
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- Neonatal Intensive Care Unit (NICU) (1)
- Newborns/Infants (3)
- Outcomes (3)
- Patient-Centered Outcomes Research (2)
- Patient Safety (3)
- Practice Patterns (1)
- Pregnancy (10)
- Racial and Ethnic Minorities (1)
- Risk (4)
- Sepsis (1)
- Sexual Health (1)
- Social Determinants of Health (1)
- Training (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 21 of 21 Research Studies DisplayedPineles BL, Harris AD, Goodman KE
Adverse maternal and delivery outcomes in children and very young (age ≤13 years) US adolescents compared with older adolescents and adults.
This study compared adverse maternal and delivery outcomes of pregnant 10- to 13-year-olds vs 14- to 17-year-olds and 18- to 19-year-olds. This cross-sectional study looked at all patients aged 10 to 19 years who delivered at hospitals in the Premier Healthcare Database from January 2019 through May 2021. The study included 90,876 deliveries across 655 US hospitals. Controlling for patient race and ethnicity, insurance type, and obesity status: 10- to 13-year-olds had significantly higher risks of preterm delivery and cesarean delivery compared with 14- to 17-year-olds. The risk of preeclampsia was not higher for 10- to 13-year-olds compared to 14- to 17-year-olds. There was a higher risk of preterm delivery for 10- to 13-year-olds compared to 18- to 19-year-olds, but not significantly different for cesarean delivery and preeclampsia.
AHRQ-funded; HS028363.
Citation: Pineles BL, Harris AD, Goodman KE .
Adverse maternal and delivery outcomes in children and very young (age ≤13 years) US adolescents compared with older adolescents and adults.
JAMA 2022 Nov 1;328(17):1766-68. doi: 10.1001/jama.2022.18340..
Keywords: Children/Adolescents, Pregnancy, Labor and Delivery, Women, Outcomes, Adverse Events, Maternal Care
Hirai AH, Owens PL, Reid LD
AHRQ Author: Owens PL, Reid LD
Associations between state-level severe maternal morbidity and other perinatal indicators.
This study used the HCUP State Inpatient Databases (HCUP-SID) to determine the correlation between state-level severe maternal morbidity (SMM) rates and perinatal indicators. HCUP-SID was analyzed from 2017 to 2019 using revised code sets for 20 indicators excluding blood transfusions. Perinatal indicators used included prepregnancy hypertension, prepregnancy diabetes, prepregnancy obesity, low-risk cesarean delivery, preterm birth, infant mortality, and maternal mortality. HCUP-SID data for 10,542,942 maternal deliveries and 11,394,752 live births from the National Vital Statistics System (NVSS) were aggregated for state-level analysis. SMM rates were significantly correlated with 2 of the 7 perinatal indicators: prepregnancy hypertension and low-risk cesarean deliveries. All other perinatal indicators were significantly associated with at least 4 of 7 other indicators, and most correlations were higher in magnitude. Maternity mortality rates were highest in the southeast.
AHRQ-authored.
Citation: Hirai AH, Owens PL, Reid LD .
Associations between state-level severe maternal morbidity and other perinatal indicators.
JAMA Netw Open 2022 Jul;5(7):e2224621. doi: 10.1001/jamanetworkopen.2022.24621..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Women, Labor and Delivery, Hospitalization
Smith AJB, Zhou RA, Sites E
Childbirths at home and in birthing centers rose during COVID-19: Oregon 2020 vs prior years.
This study’s objectives were to compare place of birth between 2020 and years before the COVID-19 pandemic and to investigate whether changes in place of birth differed between system-owned and independent hospitals and urban and rural regions in Oregon. Findings showed that, in Oregon, in-hospital births declined significantly during the first year of COVID-19 and affected system-owned hospitals more than independent ones. Further, shifts toward out-of-hospital births occurred in both urban and rural areas.
AHRQ-funded; HS024072.
Citation: Smith AJB, Zhou RA, Sites E .
Childbirths at home and in birthing centers rose during COVID-19: Oregon 2020 vs prior years.
Am J Obstet Gynecol 2022 Jul;227(1):108-11. doi: 10.1016/j.ajog.2022.03.027..
Keywords: Labor and Delivery, Pregnancy, Women, COVID-19
Hirai AH, Owens PL, Reid LD
AHRQ Author: Owens PL, Reid LD
Trends in severe maternal morbidity in the US across the transition to ICD-10-CM/PCS from 2012-2019.
This study evaluated national and state trends in severe maternal morbidity (SMM) rates from 2012 to 2019, and potential disruptions associated with the transition to International Classification of Diseases, 10th Revision, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS) in October 2015. This repeated cross-sectional analysis examined delivery hospitalizations in the HCUP’s National Inpatient Sample and State Inpatient Databases. There were almost 6 million delivery hospitalizations in the national sample representing a weighted total of 29.8 million deliveries with a mean maternal age of 28.6 years. SMM rates increased from 69.5 per 10,000 deliveries to 79.7 per 10,000 in 2019 without a significant change across the ICD-10-CM/PCS transition. OF 20 SMM indicators, rates for 10 indicators increased while 3 significantly decreased with 5 of those changes associated with the ICD-10-CM/PCS transition. Acute kidney failure had the largest increase, from 6.4 to 15.3 per 10,000 delivery hospitalizations, with no change associated with ICD transition. Disseminated intravascular coagulation had the largest decrease from 31.3 to 21.2 per 10,000, with a significant drop associated with ICD transition. State SMM rates significantly decreased for 1 state and significantly increased for 21 states from 2012 to 2019 and with varying associations with ICD transition.
AHRQ-authored.
Citation: Hirai AH, Owens PL, Reid LD .
Trends in severe maternal morbidity in the US across the transition to ICD-10-CM/PCS from 2012-2019.
JAMA Netw Open 2022 Jul;5(7):e2222966. doi: 10.1001/jamanetworkopen.2022.22966..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Pregnancy, Women, Labor and Delivery, Hospitalization
Dude AM, Schueler K, Schumm LP
Preconception care and severe maternal morbidity in the United States.
This study’s objective was to measure the association between preconception care and the odds of severe maternal morbidity among women with Medicaid using a secondary analysis of Medicaid claims using Medicaid Analytic Extract files. Findings showed that contraceptive services in the year before conception and routine exams for women with chronic disease were associated with decreased odds of severe maternal morbidity or death for Medicaid enrollees.
AHRQ-funded; HS027027.
Citation: Dude AM, Schueler K, Schumm LP .
Preconception care and severe maternal morbidity in the United States.
Am J Obstet Gynecol MFM 2022 Mar;4(2):100549. doi: 10.1016/j.ajogmf.2021.100549..
Keywords: Maternal Care, Pregnancy, Women, Labor and Delivery, Sexual Health
Flannery DD, Mukhopadhyay S, Morales KH
Delivery characteristics and the risk of early-onset neonatal sepsis.
This retrospective cohort study identified term and preterm infants at lowest risk of culture-confirmed early-onset sepsis (EOS) using delivery characteristics and also determined antibiotic use among them. The study cohort included term and preterm infants born 2009 to 2014 with blood culture with or without cerebrospinal fluid culture obtained ≤72 hours after birth. Low EOS risk criteria included: cesarean delivery, without labor or membrane rupture before delivery, and no antepartum concern for intraamniotic infection or nonreassuring fetal status. Among 53,575 births, 7549 (14.1%) were evaluated and 41 (0.5%) of those infants had EOS. For 1121 evaluated infants there were low-risk delivery characteristics and none had EOS. Duration of antibiotics administered to infants born with and without low-risk characteristics was not different.
AHRQ-funded; HS027468.
Citation: Flannery DD, Mukhopadhyay S, Morales KH .
Delivery characteristics and the risk of early-onset neonatal sepsis.
Pediatrics 2022 Feb;149(2). doi: 10.1542/peds.2021-052900..
Keywords: Newborns/Infants, Sepsis, Risk, Labor and Delivery, Antibiotics, Medication
Cliff BQ
Do high-deductible health plans affect price paid for childbirth?
The purpose of this study was to test whether out-of-pocket costs and negotiated hospital prices for childbirth change after enrollment in high-deductible health plans (HDHPs) and whether price effects differ in markets with more hospitals. Administrative medical claims data from three large commercial insurers with plans in all U.S. states was provided by the Health Care Cost Institute. Findings showed that prices for childbirth in markets with more hospitals decreased after HDHP switch due to lower hospital prices for HDHPs relative to prices at those same hospitals for non-HDHPs.
AHRQ-funded; HS025614.
Citation: Cliff BQ .
Do high-deductible health plans affect price paid for childbirth?
Health Serv Res 2022 Feb;57(1):27-36. doi: 10.1111/1475-6773.13702..
Keywords: Labor and Delivery, Health Insurance, Healthcare Costs, Women
Lyndon A, Simpson KR, Spetz J
Psychometric properties of The Perinatal Missed Care Survey and missed care during labor and birth.
The purpose of this study was to confirm reliability and validity of the Perinatal Missed Care Survey in a large sample of nurses and hospitals, test construct validity with confirmatory factor analysis, and describe the prevalence of missed nursing care during labor and birth. The study found the survey to be a valid and reliable adaptation of the original MISSCARE instrument. This survey could potentially be used to measure nursing care quality and to assess the effectiveness of structural interventions to improve quality and safety.
AHRQ-funded; HS025715.
Citation: Lyndon A, Simpson KR, Spetz J .
Psychometric properties of The Perinatal Missed Care Survey and missed care during labor and birth.
Appl Nurs Res 2022 Feb;63:151516. doi: 10.1016/j.apnr.2021.151516..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Women
Korst LM, Feldman DS, Bollman DL
Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.
The researchers examined the extent to which hospitals could be classified by increasingly sophisticated maternal levels of care. They concluded that childbirth services varied widely across California hospitals, and most hospitals did not fit easily into proposed levels. Cognizance of this existing variation is critical to determining the optimal configuration of services for basic, intermediate, and regional maternal levels of care.
AHRQ-funded; HS020915.
Citation: Korst LM, Feldman DS, Bollman DL .
Cross-sectional survey of California childbirth hospitals: implications for defining maternal levels of risk-appropriate care.
Am J Obstet Gynecol 2015 Oct;213(4):527.e1-27.e12. doi: 10.1016/j.ajog.2015.07.014..
Keywords: Labor and Delivery, Maternal Care, Hospitals, Access to Care
Feldman DS, Bollman DL, Fridman M
Do laborists improve delivery outcomes for laboring women in California community hospitals?
The researchers sought to determine the impact of the laborists staffing model on cesarean rates and maternal morbidity in California community hospitals. They were unable to demonstrate differences in cesarean and maternal childbirth complication rates in community hospitals with and without laborists.
AHRQ-funded; HS020915.
Citation: Feldman DS, Bollman DL, Fridman M .
Do laborists improve delivery outcomes for laboring women in California community hospitals?
Am J Obstet Gynecol 2015 Oct;213(4):587.e1-87.e13. doi: 10.1016/j.ajog.2015.05.051..
Keywords: Labor and Delivery, Outcomes, Patient Safety, Women
Korst LM, Feldman DS, Bollman DL
Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.
The objective of the study was to describe the resources and activities associated with childbirth services. It concluded that childbirth services varied widely across California hospitals. Cognizance of this variation and linkage of these data to childbirth outcomes should assist in the identification of key resources and activities that optimize the hospital environment for pregnant women.
AHRQ-funded; HS020915.
Citation: Korst LM, Feldman DS, Bollman DL .
Variation in childbirth services in California: a cross-sectional survey of childbirth hospitals.
Am J Obstet Gynecol 2015 Oct;213(4):523.e1-8. doi: 10.1016/j.ajog.2015.08.013..
Keywords: Labor and Delivery, Maternal Care, Hospitals, Access to Care
Tilden EL, Lee VR, Allen AJ
Cost-effectiveness analysis of latent versus active labor hospital admission for medically low-risk, term women.
The purpose of this study was to assess the outcomes and costs of hospital admission during the latent versus active phase of labor. It found that delaying admission until active labor would result in 672,000 fewer epidurals, 67,232 fewer cesarean deliveries, and 9.6 fewer maternal deaths in our theoretic cohort as compared to admission during latent labor.
AHRQ-funded; HS017582.
Citation: Tilden EL, Lee VR, Allen AJ .
Cost-effectiveness analysis of latent versus active labor hospital admission for medically low-risk, term women.
Birth 2015 Sep;42(3):219-26. doi: 10.1111/birt.12179..
Keywords: Labor and Delivery, Comparative Effectiveness, Healthcare Costs, Patient-Centered Outcomes Research, Hospitalization
Andrews SE, Alston MJ, Allshouse AA
Does the number of forceps deliveries performed in residency predict use in practice?
The researchers aimed to determine whether a threshold number of forceps deliveries in residency predicts use of forceps in independent practice. They concluded that, although exceeding 13 forceps deliveries made it highly likely that obstetricians would use them in practice, further study is necessary to set goals for a number of resident forceps deliveries that translate into use in practice.
AHRQ-funded; HS022143.
Citation: Andrews SE, Alston MJ, Allshouse AA .
Does the number of forceps deliveries performed in residency predict use in practice?
Am J Obstet Gynecol 2015 Jul;213(1):93.e1-4. doi: 10.1016/j.ajog.2015.03.025..
Keywords: Labor and Delivery, Patient-Centered Outcomes Research, Practice Patterns, Training, Women
Cavazos-Rehg PA, Krauss MJ, Spitznagel EL
Maternal age and risk of labor and delivery complications.
The researchers examined associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. Using HCUP data, they found that complications with the highest odds among women 11-18 years of age included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women 15-19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women 35 and older had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Women over 40 had increased odds for mild preeclampsia, fetal distress, and poor fetal growth.
AHRQ-funded; HS019455.
Citation: Cavazos-Rehg PA, Krauss MJ, Spitznagel EL .
Maternal age and risk of labor and delivery complications.
Matern Child Health J 2015 Jun;19(6):1202-11. doi: 10.1007/s10995-014-1624-7.
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Keywords: Adverse Events, Healthcare Cost and Utilization Project (HCUP), Labor and Delivery, Pregnancy, Risk
Camelo Castillo W, Boggess K, Sturmer T
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
The purpose of this study was to estimate the risks of adverse pregnancy outcomes among women receiving glyburide compared with insulin for the treatment of gestational diabetes mellitus (GDM) in a US population-based cohort. It found an association between glyburide (compared with insulin) and elevated risk of NICU admission, neonatal hypoglycemia, respiratory distress, birth injury, and large for gestational age in women with GDM.
AHRQ-funded; HS017950.
Citation: Camelo Castillo W, Boggess K, Sturmer T .
Association of adverse pregnancy outcomes with glyburide vs insulin in women with gestational diabetes.
JAMA Pediatr 2015 May;169(5):452-8. doi: 10.1001/jamapediatrics.2015.74..
Keywords: Adverse Drug Events (ADE), Adverse Events, Comparative Effectiveness, Diabetes, Labor and Delivery, Maternal Care, Medication, Newborns/Infants, Outcomes, Pregnancy, Women
Huesch M, Doctor JN
Factors associated with increased cesarean risk among African American women: evidence from California, 2010.
The researchers studied the association of maternal health in African American women in hospitals or communities with the rates of cesarean delivery of infants. They found that cesarean rates were significantly higher overall for African American women than other women (unadjusted rate 36.8 percent vs 32.7 percent), as were both elective and emergency primary cesarean rates.
AHRQ-funded; HS021868.
Citation: Huesch M, Doctor JN .
Factors associated with increased cesarean risk among African American women: evidence from California, 2010.
Am J Public Health 2015 May;105(5):956-62. doi: 10.2105/ajph.2014.302381..
Keywords: Labor and Delivery, Maternal Care, Racial and Ethnic Minorities
Metz TD, Allshouse AA, Faucett AM
Validation of a vaginal birth after cesarean delivery prediction model in women with two prior cesarean deliveries.
This study evaluated whether an existing vaginal birth after cesarean (VBAC) prediction model validated for women with one prior cesarean delivery also accurately predicts the likelihood of VBAC in women with two prior cesarean deliveries. It found that the estimates of VBAC success based on the Maternal-Fetal Medicines Units prediction model are similar to the actual rates observed among women with two prior cesarean deliveries.
AHRQ-funded; HS022143.
Citation: Metz TD, Allshouse AA, Faucett AM .
Validation of a vaginal birth after cesarean delivery prediction model in women with two prior cesarean deliveries.
Obstet Gynecol 2015 Apr;125(4):948-52. doi: 10.1097/aog.0000000000000744..
Keywords: Labor and Delivery, Pregnancy, Women
Marshall NE, Vanderhoeven J, Eden KB
Impact of simulation and team training on postpartum hemorrhage management in non-academic centers.
The researchers conducted a multi-center study to evaluate in situ simulation and team training for postpartum hemorrhage management (PPH) among experienced clinical teams in non-academic hospitals in urban and rural communities. They found that team training significantly improved response times in the management of PPH, including the recognition of PPH, time to administer first medication, performance of uterine massage and time to administer second medication.
AHRQ-funded; HS015800; HS016673.
Citation: Marshall NE, Vanderhoeven J, Eden KB .
Impact of simulation and team training on postpartum hemorrhage management in non-academic centers.
J Matern Fetal Neonatal Med 2015 Mar;28(5):495-9. doi: 10.3109/14767058.2014.923393..
Keywords: Training, Patient Safety, Labor and Delivery, Women
Santos P, Ritter GA, Hefele JL
Decreasing intrapartum malpractice: targeting the most injurious neonatal adverse events.
The researchers conducted a case study of a risk reduction labor and delivery model at 5 demonstration sites. After 27 months post implementation, reporting of unintended events increased significantly (43 vs 84 per 1000 births), while high-risk malpractice events decreased significantly (14 vs 7 per 1000 births).
AHRQ-funded; HS019608.
Citation: Santos P, Ritter GA, Hefele JL .
Decreasing intrapartum malpractice: targeting the most injurious neonatal adverse events.
J Healthc Risk Manag 2015;34(4):20-7. doi: 10.1002/jhrm.21168..
Keywords: Labor and Delivery, Patient Safety, Risk, Medical Liability, Medical Errors
Witt WP, Wisk LE, Cheng ER
Determinants of cesarean delivery in the US: a lifecourse approach.
The researchers sought to determine whether the effects of preconception stressful life events (PSLEs) on birth weight differed by neighborhood disadvantage. They found that the risk of having very low birthweight infants among women with PSLEs, women with chronic conditions, or minority women was strongest among those living in disadvantaged neighborhoods, which suggests exacerbation of risk within disadvantaged environments.
AHRQ-funded; HS000083; HS000063.
Citation: Witt WP, Wisk LE, Cheng ER .
Determinants of cesarean delivery in the US: a lifecourse approach.
Matern Child Health J 2015 Jan;19(1):84-93. doi: 10.1007/s10995-014-1498-8..
Keywords: Labor and Delivery, Maternal Care, Pregnancy, Risk, Social Determinants of Health
Kastenberg ZJ, Lee HC, Profit J
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.
The study’s aims were to describe the current trend toward deregionalization and to test the hypothesis that infants with necrotizing enterocolitis represent a particularly high-risk subgroup of the VLBW population that would benefit from early identification, increased intensity of early management, and possible targeted triage to tertiary hospitals. It found that outcomes for VLBW infants continue to be suboptimal when they are not born into high-level, high-volume centers.
AHRQ-funded; HS000028.
Citation: Kastenberg ZJ, Lee HC, Profit J .
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis.
JAMA Pediatr 2015 Jan;169(1):26-32. doi: 10.1001/jamapediatrics.2014.2085..
Keywords: Newborns/Infants, Labor and Delivery, Mortality, Neonatal Intensive Care Unit (NICU), Healthcare Delivery