Incarceration associated with greater incidence of adverse pregnancy outcomes

Among pregnant women hospitalized for delivery, those who were incarcerated had higher rates of adverse pregnancy outcomes and medical conditions, according to a cross-sectional analysis in the American Journal of Obstetrics & Gynecology.

Specifically, researchers found that incarceration was associated with significantly greater odds of preterm delivery and abruption and antepartum hemorrhage.

“About 4% of women who enter U.S. prisons and jails will be pregnant at intake and will require prenatal care tailored to meet these needs,” Teresa C. Logue, MPH, of Columbia University Irving Medical Center Department of OB/GYN in New York, and colleagues wrote. “There is limited and inconsistent data on risk for preterm delivery in this population and no data on risk for other pregnancy complications, such as severe maternal morbidity. Outcomes may be poorer because of limited or suboptimal care.”

Logue and colleagues analyzed delivery hospitalizations from Oct. 1, 2015, to Dec. 31, 2018, included in the National Inpatient Sample. They identified 12 million women aged 15 to 54 years who were hospitalized for delivery, 1,580 (0.01%) of whom had an ICD diagnosis of incarceration.

Women who had an incarceration diagnosis were more likely to have a mental health condition (standardized mean difference [SMD], 52%), substance use disorder (SMD, 89.4%), viral hepatitis (SMD, 57.1%) and sexually transmitted infections (SMD, 24.4%) compared with those who did not. They were also more likely to use tobacco (SMD, 66.4%), use Medicaid insurance (59.49% vs. 42.83%) and be in a lower income quartile (SMD for 36.5% ZIP code-income quartile).

Compared with women who did not have an incarceration diagnosis, those who did had higher rates of non-transfusion severe maternal morbidity (1.9% vs. 0.78%), hypertensive disorders of pregnancy (12.34% vs. 10.55%), preterm delivery (10.44% vs. 4.52%), postpartum hemorrhage (4.11% vs. 3.64%), cesarean delivery (34.81% vs. 32.22%) and abruption and antepartum hemorrhage (3.48% vs. 1.52%). With adjustment, the odds of having a preterm delivery (aOR = 2.15; 95% CI, 1.53-3.02) and abruption and antepartum hemorrhage (aOR = 2.1; 95% CI, 1.1-4.01) remained significantly higher among women diagnosed with incarceration.

“Our findings suggest there is a need for better monitoring of pregnancy complications in this high-risk population as well as improvements in care quality and access,” Logue and colleagues wrote.