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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 15 of 15 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
Williams D, Stout MJ, Rosenbloom JI
Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction.
Preeclampsia is associated with increased risk of future heart failure (HF), but the relationship between preeclampsia and HF subtypes are not well-established. The objective of this analysis was to identify the risk of HF with preserved ejection fraction (HFpEF) following a delivery complicated by preeclampsia/eclampsia. The investigators concluded that preeclampsia/eclampsia was an independent risk factor for future hospitalizations for HFpEF.
AHRQ-funded; HS019455.
Citation: Williams D, Stout MJ, Rosenbloom JI .
Preeclampsia predicts risk of hospitalization for heart failure with preserved ejection fraction.
J Am Coll Cardiol 2021 Dec 7;78(23):2281-90. doi: 10.1016/j.jacc.2021.09.1360..
Keywords: Healthcare Cost and Utilization Project (HCUP), Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Risk, Labor and Delivery, Pregnancy, Women
Admon LK, Dalton VK, Kolenic GE
Comparison of delivery-related, early and late postpartum severe maternal morbidity among individuals with commercial insurance in the US, 2016 to 2017.
This study analyzed data from 2016 to 2017 on delivery-related, early, and late postpartum severe maternal morbidity (SMM) among individuals with commercial insurance by race and ethnicity and perinatal mood and anxiety disorder (PMAD) status. This cross-sectional study of deidentified claims data from the Optum Clinformatics Data Mart evaluated rates of SMM during 3 pregnancy periods among individuals aged 15 to 44 years. The study sample comprised of 100,982 individuals with a mean age of 31.6 years. SMM rates were compared for pregnancies with and without complications, with blood transfusions being the number one indicator for pregnancy and postpartum periods with SMM. Rates of SMM with and without blood transfusion varied by race and ethnicity and PMAD status. Higher rates of SMM were identified among Black individuals compared with White individuals for the pregnancy, early postpartum, and late postpartum periods, respectively. Higher rates of blood transfusion were also identified in each of the 3 periods among individuals with PMADs compared to individuals without PMADs.
AHRQ-funded; HS027640.
Citation: Admon LK, Dalton VK, Kolenic GE .
Comparison of delivery-related, early and late postpartum severe maternal morbidity among individuals with commercial insurance in the US, 2016 to 2017.
JAMA Netw Open 2021 Dec;4(12):e2137716. doi: 10.1001/jamanetworkopen.2021.37716..
Keywords: Labor and Delivery, Pregnancy, Maternal Care, Pregnancy, Health Insurance, Racial and Ethnic Minorities, Anxiety
Zochowski MK, Kolenic GE, Zivin K
Trends in primary cesarean section rates among women with and without perinatal mood and anxiety disorders.
Reducing the rate of cesarean sections among women considered at low risk for delivery by that method is a goal of Healthy People 2030. Prior research suggests that perinatal mood and anxiety disorders increase the risk for cesarean section, but data are limited. This cross-sectional study of commercially insured women examined the relationship between perinatal depression and anxiety disorders and primary (first-time) cesarean section rates, using administrative claims data for US in-hospital deliveries from the period 2008-17.
AHRQ-funded; HS027640.
Citation: Zochowski MK, Kolenic GE, Zivin K .
Trends in primary cesarean section rates among women with and without perinatal mood and anxiety disorders.
Health Aff 2021 Oct;40(10):1585-91. doi: 10.1377/hlthaff.2021.00780..
Keywords: Labor and Delivery, Pregnancy, Women, Anxiety
Schwartz GL, Leifheit KM, Berkman LF
Health selection into eviction: adverse birth outcomes and children's risk of eviction through age 5 years.
Adverse birth outcomes put children at increased risk of poor future health. They also put families under sudden socioeconomic and psychological strain, which has poorly understood consequences. In this study, the investigators tested whether infants experiencing an adverse birth outcome-low birthweight or prematurity, as well as lengthy hospital stays-were more likely to be evicted in early childhood, through age 5 years.
AHRQ-funded; HS000046.
Citation: Schwartz GL, Leifheit KM, Berkman LF .
Health selection into eviction: adverse birth outcomes and children's risk of eviction through age 5 years.
Am J Epidemiol 2021 Jul;190(7):1260-69. doi: 10.1093/aje/kwab007..
Keywords: Children/Adolescents, Newborns/Infants, Labor and Delivery, Pregnancy
Chua KP, Fendrick AM, Conti RM
Out-of-pocket spending for deliveries and newborn hospitalizations among the privately insured.
The authors estimated national data on out-of-pocket spending across the childbirth episode, including both deliveries and newborn hospitalizations, using national commercial claims data. They found that, during 2016–2019, privately insured families paid $3000 out-of-pocket for maternal and newborn hospitalizations, with out-of-pocket spending exceeding $5000 for 1 in 6 families. They recommended that clinicians counsel privately insured families concerning their childbirth benefits.
Citation: Chua KP, Fendrick AM, Conti RM .
Out-of-pocket spending for deliveries and newborn hospitalizations among the privately insured.
Pediatrics 2021 Jul;148(1):e2021050552. doi: 10.1542/peds.2021-050552..
Keywords: Newborns/Infants, Labor and Delivery, Pregnancy, Healthcare Costs
Calthorpe LM, Baer RJ, Chambers BD
The association between preterm birth and postpartum mental healthcare utilization among California birthing people.
This study’s objective was to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization. The study sample was taken from a database of live-born neonates delivered in California, 2011-2017, and included all births to singleton infants between the gestational ages of 20 and 44 weeks. The findings indicate found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. These findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.
AHRQ-funded; HS026383.
Citation: Calthorpe LM, Baer RJ, Chambers BD .
The association between preterm birth and postpartum mental healthcare utilization among California birthing people.
Am J Obstet Gynecol MFM 2021 Jul;3(4):100380. doi: 10.1016/j.ajogmf.2021.100380..
Keywords: Behavioral Health, Pregnancy, Women, Labor and Delivery, Risk
Wilson BL, Butler RJ
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. In this study the investigators examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing.
AHRQ-funded; HS024607.
Citation: Wilson BL, Butler RJ .
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Nurs Outlook 2021 Jan-Feb;69(1):84-95. doi: 10.1016/j.outlook.2020.07.003..
Keywords: Provider: Nurse, Provider, Workforce, Labor and Delivery, Pregnancy, Quality of Care, Risk, Women