Higher postpartum readmission risk after stillbirth delivery vs. live birth
Click Here to Manage Email Alerts
Key takeaways:
- Within 6 weeks of delivery, readmission risk was higher after stillbirth vs. live birth.
- Mental health/substance use disorders and venous thromboembolism accounted for more readmissions after stillbirths vs. live births.
Postpartum readmission risk was higher for women with stillbirth vs. live birth deliveries, with mental health/substance use disorders and thromboembolism accounting for more, and hypertension fewer, readmissions following stillbirth.
“Stillbirth occurs more commonly in pregnant people with comorbid conditions and obstetric complications, who tend to experience an increased risk of maternal morbidity. Some studies also suggest that stillbirth itself may independently increase maternal risk for morbidity regardless of patients’ baseline health status,” Lena C. Sweeney, MD, an instructor in the department of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine, and colleagues wrote. “These unique medical factors and the psychosocial burden associated with stillbirth may increase patients’ need for subsequent care and influence transitional care after discharge, leading to a higher risk for postpartum readmission.”
Sweeney and colleagues conducted a retrospective cohort study evaluating data from 16,636 singleton stillbirths and 2,870,677 singleton live births delivered at 20 weeks gestation or later from the 2019 Nationwide Readmissions Database. Researchers evaluated associations between stillbirth and hospital readmission risk compared with live births.
Primary outcome was all-cause readmission within 6 weeks of discharge after childbirth. Secondary outcomes included principal indication for readmission and readmission timing.
Results, published in the American Journal of Obstetrics and Gynecology, demonstrated postpartum readmission within 6 weeks of discharge among 2.7% of women who had stillbirth deliveries compared with 1.6% of women with live birth deliveries (RR = 1.65; 95% CI, 1.47-1.86). Risk for readmission remained higher for women with stillbirth vs. live birth deliveries even after adjusting for maternal, obstetric and delivery characteristics (adjusted RR = 1.27; 95% CI, 1.11-1.46).
Mental health and/or substance use disorders (6.8% vs. 3.6%; RR = 1.9; 95% CI, 1.15-3.16) and venous thromboembolism (5.8% vs. 2%; RR = 2.87; 95% CI, 1.6-5.17) accounted for a larger proportion of readmissions after stillbirth compared with live birth delivery. Conversely, compared with live birth delivery, hypertension accounted for a lower proportion of readmissions after stillbirth delivery (30.2% vs. 39.5%; RR = 0.76; 95% CI, 0.63-0.93).
Readmission timing did not significantly differ between stillbirth vs. live birth deliveries. Of women with stillbirth deliveries, 56% of readmissions occurred within 1 week after hospital discharge, 71.8% occurred within 2 weeks and 88.1% occurred within 4 weeks.
Pregestational diabetes (aRR = 1.87; 95% CI, 1.2-2.93), gestational diabetes (aRR = 1.67; 95% CI, 1.03-2.71), hypertensive disorders of pregnancy (aRR = 1.8; 95% CI, 1.31-2.47), obesity (aRR = 1.46; 95% CI, 1.01-2.12) and primary cesarean delivery (aRR = 1.74; 95% CI, 1.17-2.58) were all associated with a higher readmission risk after stillbirth delivery. However, higher annual household incomes of $82,000 or higher were associated with a lower readmission risk after stillbirth compared with annual household incomes of $47,999 or lower (aRR = 0.48; 95% CI, 0.3-0.77).
“Our results on stillbirth-specific indications and risk factors for readmission may inform clinicians in individualizing postpartum care plans and follow-up to help mitigate readmission risk,” the researchers wrote. “Given the ensuing psychosocial and physical toll affecting birthing people after stillbirth, continued effort is needed to understand how stillbirth affects other areas of postpartum care and to identify effective interventions for addressing care needs.”