BACKGROUND
Compared to women with a live birth, women with a stillbirth are more likely to have
maternal complications during pregnancy and at birth, but risk factors related to
their postpartum health are uncertain.
OBJECTIVE
This study aimed to identify patient-level risk factors for postpartum hospital readmission
among women after having a stillbirth.
STUDY DESIGN
This was a population-based cohort study of 29,654 women with a stillbirth in California
from 1997 to 2011. Using logistic regression models, we examined the association of
maternal patient-level factors with postpartum readmission among women after a stillbirth
within 6 weeks of hospital discharge and between 6 weeks and 9 months after delivery.
RESULTS
Within 6 weeks after a stillbirth, 642 women (2.2%) had a postpartum readmission.
Risk factors for postpartum readmission after a stillbirth were severe maternal morbidity
excluding transfusion (adjusted odds ratio, 3.02; 95% confidence interval, 2.28–4.00),
transfusion at delivery but no other indication of severe maternal morbidity (adjusted
odds ratio, 1.95; 95% confidence interval, 1.35–2.81), gestational hypertension or
preeclampsia (adjusted odds ratio, 1.93; 95% confidence interval, 1.54–2.42), prepregnancy
hypertension (adjusted odds ratio, 1.80; 95% confidence interval, 1.36–2.37), diabetes
mellitus (adjusted odds ratio, 1.78; 95% confidence interval, 1.33–2.37), antenatal
hospitalization (adjusted odds ratio, 1.78; 95% confidence interval, 1.43–2.21), cesarean
delivery (adjusted odds ratio, 1.73; 95% confidence interval, 1.43–2.21), long length
of stay in the hospital after delivery (>2 days for vaginal delivery and >4 days for
cesarean delivery) (adjusted odds ratio, 1.59; 95% confidence interval, 1.33–1.89),
non-Hispanic black race and ethnicity (adjusted odds ratio, 1.38; 95% confidence interval,
1.08–1.76), and having less than a high school education (adjusted odds ratio, 1.35;
95% confidence interval, 1.02–1.80). From 6 weeks to 9 months, 1169 women (3.90%)
had a postpartum readmission; significantly associated risk factors were largely similar
to those for earlier readmission.
CONCLUSION
Women with comorbidities, with birth-related complications, of non-Hispanic black
race and ethnicity, or with less education had increased odds of postpartum readmission
after having a stillbirth, highlighting the importance of continued care for these
women after discharge from the hospital.
Key words
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Article info
Publication history
Published online: March 08, 2021
Accepted:
March 4,
2021
Received in revised form:
February 17,
2021
Received:
November 18,
2020
Footnotes
The authors report no conflict of interest.
This work was supported by the National Institutes of Health (NR017020 and HD095034) and the Department of Anesthesiology, Perioperative, and Pain Medicine and the Department of Obstetrics and Gynecology, Stanford University School of Medicine.
The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
The State of California Committee for the Protection of Human Subjects and the Stanford University Research Compliance Office approved the study protocol. Informed consent was not obtained because the institutional review boards deemed the research involved no more than minimal risk to the participants, the waiver would not adversely affect the rights and welfare of the participants, and the research could not practically be carried out without the waiver. Permission was obtained by the institutional review boards to access the data used in the study.
The study data are available by request from the California Office of Statewide Health Planning and Development.
This abstract was presented as a poster presentation at the 3rd annual meeting of the Maternal and Child Health Research Institute in Stanford, California on November 6, 2020.
Cite this article as: DiTosto JD, Liu C, Wall-Wieler E, et al. Risk factors for postpartum readmission among women after having a stillbirth. Am J Obstet Gynecol MFM 2021;XX:x.ex–x.ex.
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