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2002 PRAMS Surveillance Report: Multistate Exhibits
Hospitalizations for Pregnancy-Related Complications |
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Data Highlights | References | Tables
Background
Maternal morbidity is generally defined as any illness or injury caused by, aggravated by, or associated with pregnancy or childbirth.1 Maternal morbidity affects not only a woman's health, but also the health of her fetus or infant.2 Severe maternal morbidity may lead to fetal, infant, or maternal death.2–4
Currently, limited data exist for monitoring national trends in maternal morbidity. Hospitalization rates for pregnancy-related complications have been the primary means for measuring maternal morbidity.5 Researchers have found that cases of maternal morbidity severe enough to require hospitalization occur frequently during pregnancy.3,6,7 The most common reasons for hospitalizations during pregnancy are preterm labor, nausea or vomiting, genitourinary complications, and hypertensive disorders.3,7,8
Using multiyear data from the National Hospital Discharge Survey (NHDS), Bacak and colleagues8 estimated 12.8 pregnancy-associated hospitalizations for every 100 U.S. births during 1999 through 2000, compared with 17.6 during 1991 through 1992. Antenatal hospitalizations declined from 13.3 per 100 deliveries in 1991–1992 to 10.5 in 1999–2000, and hospitalizations related to early pregnancy loss declined from 4.3 per 100 deliveries in 1991–1992 to 2.3 in 1999–2000. Women who were younger than 24, African American, and those whose source of payment was self-pay had the highest pregnancy-associated and antenatal hospitalization ratios.8
The use of hospitalization rates to monitor temporal changes in maternal morbidity is problematic, however, because of changes in clinical practice that have led to greater outpatient management of conditions in more recent years.8 A study using pregnancy-related discharge data from a national managed care organization found that overall only 8.7% of women who had a live birth or pregnancy loss in 1997 were hospitalized during pregnancy: 5.7% were hospitalized and discharged while pregnant, 0.8% experienced an extended stay (≥ 4 days) before a live birth or pregnancy loss, and 2.1% experienced a pregnancy loss.7 The cost of these hospitalizations was over $36 million.7
In another recent study, Danel and colleagues used data from the NHDS for 1993–1997 and found that 43% of women experienced some type of morbidity during hospitalization for delivery: 31% had at least one obstetric complication or at least one pre-existing medical condition, and 12% had a cesarean section.9 Despite the apparent improvement in pregnancy-related hospitalization rates, racial disparities persist. In 1991–1992, Bennett and colleagues3 found that African American women had a pregnancy-related hospitalization rate of 28.1 per 100 deliveries compared with 17.2 among white women. In 1999–2000 Bacak and colleagues8 found a similar gap in the pregnancy-related hospitalization rates for African American (21.3 per 100 deliveries) and white women (12.1 per 100 deliveries). Gregory and Korst10 also found racial disparities in the prevalence of pregnancy-related complications in California discharge data for 1995. These researchers found that 26% of women with discharges for deliveries had at least one recorded maternal, fetal, or placental problem, but that the overall prevalence of any given problem was low (< 5%), and that African American women were at increased risk compared with white women for one-third of the 31 conditions studied.10
The PRAMS survey collects data on selected problems women experienced during pregnancy, regardless of care setting. These problems include preterm or early labor; high blood pressure; vaginal bleeding; problems with the placenta; severe nausea, vomiting, or dehydration; diabetes; kidney or bladder infection; premature rupture of the membranes; incompetent cervix or cerclage; and injuries from car accidents. PRAMS also collects data on whether women who experienced any of these problems went to the hospital or stayed in bed at home at the suggestion of a doctor or nurse, and the length of time that they were at the hospital or at home on bed rest. States can use the data on pregnancy complications from PRAMS to monitor patterns and trends in the prevalence and severity of selected pregnancy-related complications.
Using 2000 PRAMS data for 19 states, Williams and colleagues11 found that the percentage of women who required a hospital stay of 1 or more days for these conditions ranged from 8.8% in Utah to 16.3% in Louisiana. Furthermore, Williams and colleagues11 found associations between race and pregnancy-related complications in 6 of the 19 states. Compared with white women, black women had a significantly higher prevalence of the selected pregnancy-related complications that required hospitalizations of 1 or more days in 2 states (North Carolina and South Carolina), and Hispanic women had a significantly lower prevalence in 3 of the 16 states for which data were available for Hispanic populations (Alabama, Colorado, and Oklahoma).
Data Highlights
- In 2002, the prevalence of pregnancy-related complications that required a hospital stay of at least 1 day ranged from 8.0% (Washington) to 17.7% (West Virginia).
- During 2000–2002, the prevalence of pregnancy-related complications requiring a hospital stay of 1 or more days decreased in 1 state (Washington) and increased in 1 state (Alabama).
References
- National Research Council Committee on Population, Commission on Behavioral and Social Sciences and Education. Reed HE, Koblinsky MA, Mosley WH, Editors. The Consequences of Maternal Morbidity and Maternal Mortality: Report of a Workshop. Washington, DC: National Academy Press; 2000.
- Scott CL, Chavez GF, Atrash HK, Taylor DJ, Shah RS, Rowley D. Hospitalizations for severe complications of pregnancy, 1987–1992. Obstetrics and Gynecology 1997;90(2):225–229.
- Bennett TA, Kotelchuck M, Cox CE, Tucker MJ, Nadeau DA. Pregnancy-associated hospitalizations in the United States in 1991 and 1992: a comprehensive view of maternal morbidity. American Journal of Obstetrics and Gynecology 1998;178(2):346–354.
- Becerra JE, Rowley DL, Atrash HK. Case fatality rates associated with conditions originating in the perinatal period: United States, 1986 through 1987. Pediatrics 1992;89(6 Pt 2):1256–1259.
- Berg CJ, Bruce FC, Callaghan WM. From mortality to morbidity: the challenge of the twenty-first century. Journal of the American Medical Women's Association 2002;57(3):173–174.
- Franks AL, Kendrick JS, Olson DR, Atrash HK, Saftlas AF, Moien M. Hospitalization for pregnancy complications, United States, 1986 and 1987. American Journal of Obstetrics and Gynecology 1992;166(5):1339–1344.
- Gazmararian JA, Petersen R, Jamieson DJ, Schild L, Adams MM, Deshpande AD, et al. Hospitalizations during pregnancy among managed care enrollees. Obstetrics and Gynecology 2002;100(1):94–100.
- Bacak SJ, Callaghan WM, Dietz PM, Crouse C. Pregnancy-associated hospitalizations in the United States, 1999–2000. American Journal of Obstetrics and Gynecology. 2005;192(2):592–597.
- Danel I, Berg C, Johnson CH, Atrash H. Magnitude of maternal morbidity during labor and delivery: United States, 1993–1997. American Journal of Public Health 2003;93(4):631–634.
- Gregory KD, Korst LM. Age and racial/ethnic differences in maternal, fetal, and placental conditions in laboring patients. American Journal of Obstetrics and Gynecology. 2003;188(6):1602–1608.
- Williams LM, Morrow B, Lansky A, Beck LF, Barfield W, Helms K, et al. Surveillance for selected maternal behaviors and experiences before, during, and after pregnancy. Pregnancy Risk Assessment Monitoring System (PRAMS), 2000. MMWR Surveillance Summaries 2003;52(SS-11):1–14.
Prevalence of Pregnancy-Related Complications That Required a Hospital Stay of At Least 1 Day, 2002
| State |
Respondents |
Percent† |
Standard Error |
95% CI‡ |
| Alabama |
1,556 |
17.4 |
1.1 |
15.4–19.7 |
| Alaska |
1,616 |
11.7 |
0.8 |
10.1–13.4 |
| Arkansas |
1,967 |
12.7 |
0.9 |
11.0–14.6 |
| Colorado |
2,279 |
10.5 |
0.8 |
9.1–12.0 |
| Florida |
2,008 |
13.1 |
1.0 |
11.3–15.2 |
| Hawaii |
1,804 |
9.9 |
0.9 |
8.4–11.7 |
| Illinois |
1,926 |
12.5 |
0.8 |
11.1–14.1 |
| Louisiana |
1,672 |
17.4 |
1.0 |
15.5–19.5 |
| Maine |
1,138 |
11.0 |
1.0 |
9.2–13.1 |
| Maryland |
1,450 |
10.7 |
1.1 |
8.7–13.0 |
| Michigan |
1,514 |
13.2 |
0.9 |
11.5–15.1 |
| Minnesotaa |
1,143 |
9.9 |
1.1 |
7.9–12.3 |
| Montana |
1,042 |
10.7 |
1.0 |
9.0–12.7 |
| Nebraska |
1,887 |
12.1 |
0.9 |
10.4–14.0 |
| New Jerseyb |
943 |
12.7 |
1.2 |
10.5–15.4 |
| New Mexico |
1,548 |
12.5 |
0.9 |
10.9–14.4 |
| New Yorkc |
1,226 |
10.1 |
1.0 |
8.3–12.2 |
| North Carolina |
1,542 |
13.6 |
1.0 |
11.8–15.6 |
| North Dakota |
907 |
10.1 |
1.0 |
8.3–12.2 |
| Ohio |
1,374 |
12.2 |
1.0 |
10.4–14.4 |
| Oklahoma |
1,871 |
12.9 |
1.1 |
10.9–15.4 |
| Rhode Island |
1,411 |
10.6 |
0.8 |
9.0–12.3 |
| South Carolina |
1,375 |
13.4 |
1.3 |
11.0–16.2 |
| Utah |
1,569 |
8.6 |
0.8 |
7.2–10.3 |
| Vermont |
1,104 |
11.1 |
0.9 |
9.5–12.9 |
| Washington |
1,513 |
8.0 |
1.0 |
6.3–10.1 |
| West Virginia |
1,682 |
17.7 |
1.2 |
15.4–20.2 |
| All PRAMS states§ |
41,067 |
12.3 |
0.2 |
11.9–12.8 |
† 2002 state range is 8.0–17.7%.
‡ Confidence interval.
§ Aggregate of the 27 PRAMS states.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City. |
Prevalence of Pregnancy-Related Complications That Required a Hospital Stay of At Least 1 Day, 2002
Prevalence of Pregnancy-Related Complications That Required a Hospital Stay of At Least 1 Day, 2000–2002
| State |
2000
(%) |
2001
(%) |
2002
(%) |
P value
for trend# |
| Alabama |
13.0 |
15.3 |
17.4 |
0.003* |
| Alaska |
11.1 |
11.7 |
11.7 |
0.605 |
| Arkansas |
14.0 |
14.3 |
12.7 |
0.378 |
| Colorado |
10.7 |
11.4 |
10.5 |
0.804 |
| Florida |
12.2 |
12.6 |
13.1 |
0.515 |
| Hawaii |
9.2 |
11.4 |
9.9 |
0.506 |
| Illinois |
11.7 |
12.6 |
12.5 |
0.403 |
| Louisiana |
16.3 |
15.9 |
17.4 |
0.432 |
| Maine |
12.2 |
10.5 |
11.0 |
0.391 |
| Maryland |
— |
11.6d |
10.7 |
# # |
| Michigan |
— |
13.9e |
13.2 |
# # |
| Minnesota |
— |
— |
9.9a |
# # |
| Montana |
— |
— |
10.7 |
# # |
| Nebraska |
10.4 |
12.8 |
12.1 |
0.187 |
| New Jersey |
— |
— |
12.7b |
# # |
| New Mexico |
13.4 |
11.5 |
12.5 |
0.485 |
| New Yorkc |
11.3 |
10.2 |
10.1 |
0.404 |
| North Carolina |
13.1 |
12.9 |
13.6 |
0.713 |
| North Dakota |
— |
— |
10.1 |
# # |
| Ohio |
13.2 |
10.4 |
12.2 |
0.504 |
| Oklahoma |
12.0 |
11.8 |
12.9 |
0.568 |
| Rhode Island |
— |
— |
10.6 |
# # |
| South Carolina |
14.8 |
17.1 |
13.4 |
0.441 |
| Utah |
8.8 |
8.4 |
8.6 |
0.886 |
| Vermont |
—f |
10.5f |
11.1 |
# # |
| Washington |
11.3 |
10.8 |
8.0 |
0.027* |
| West Virginia |
15.1 |
16.2 |
17.7 |
0.117 |
# Based on a test for linear trend using logistic regression.
* p value is less than 0.05.
# # < 3 years of data available; test for linear trend not applicable.
a Data represent Minnesota births from May–December 2002.
b Data represent New Jersey births from July–December 2002.
c Data exclude New York City.
d Data represent Maryland births from February–December 2001.
e Data represent Michigan births from July–December 2001.
f Data represent Vermont births from October 2000–December 2001. |
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Page last reviewed: 8/23/06
Page last modified: 8/23/06
Content source: Division
of Reproductive Health,
National Center for Chronic Disease
Prevention and Health Promotion |
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