Prevalence and Characteristics of Emergency Department Visits by Pregnant People: an analysis of a national emergency department sample (2010-2020) (Preprint)

Abstract

BACKGROUND Complications of pregnancy are common emergency department (ED) complaints. Care for pregnant patients will be significantly impacted by the increasing individual state level restrictions on reproductive healthcare following the repeal of Roe v. Wade. To address these changes, the population of pregnant patients must be clearly understood, but this population is not well-described in the literature. OBJECTIVE We aimed to estimate the number of ED visits for pregnant patients in the United States and determine the characteristics of this population using a national sample. METHODS We conducted a secondary analysis of the 2010-2020 National Hospital Ambulatory Medical Care Survey (NHAMCS), a survey designed to capture a nationally representative sample of ED visits. We evaluated visits for female patients 15-44 years old in this sample and identified visits with pregnant patients based on discharge diagnosis codes. We compared the characteristics of pregnant to non-pregnant patients and estimated the number of new pregnancies diagnosed in the ED. Using multivariable logistic regression, we determined visit characteristics associated with visits for pregnant patients versus non-pregnant patients. RESULTS The 2010-2020 NHAMCS database included 255,963 visits (weighted n = 1,502,215,000), and 59,080 visits among women ages 15-44 (weighted n=353,012,00). Pregnant patients accounted for 3.0% (95% CI 2.7-3.2) of all ED visits and 8.6% (95% CI, 8-9.3) of visits for female patients ages 15-44. This is equivalent to approximately 2.77 million visits for pregnant patients annually. Pregnant patients presenting for care were more likely to be publicly insured, Hispanic, or Black. We estimated that pregnancy was first diagnosed during 13.3% (95% CI 11.8-14.9) of ED visits for pregnant patients. CONCLUSIONS A large number for pregnant patients present for care in the ED annually. Given the potential effects of the overturn of Roe v. Wade on pregnant patients, ED-based interventions should be considered to address changes in availability of healthcare resources.

Initiating medical abortion in an emergency department in the United States

“…In the United States (US), emergency departments (EDs) are a key source of healthcare for a substantial number of pregnant individuals, with an estimated 2.77 million pregnant patients seeking care annually 1. Among women of reproductive age visiting EDs, 6% are found to be newly pregnant, highlighting the ED’s crucial role in early pregnancy detection for both planned and unplanned pregnancies 2.…”

“…For patients who learn of their pregnancies in the ED, the current standard of care often leads to dissatisfaction, a lack of alternatives for undesired pregnancies, and a failure to address the diverse emotional responses experienced in these situations 7. These issues are particularly pronounced among pregnant patients between the ages of 18–44 years who visit the ED, as they are disproportionately Black, Hispanic and/or of lower socioeconomic status compared with non-pregnant women 1. These groups already face significant challenges in accessing reproductive healthcare, a situation exacerbated by recent legal developments, including the Dobbs decision 8–10.…”