Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis
To compare maternal obstetric complications and nonelective readmissions in women with common neurologic comorbidities (WWN) vs women without neurologic disorders. We performed a retrospective cohort study of index characteristics and acute postpartum, nonelective rehospitalizations from the 2015-20...
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| Veröffentlicht in: | Neurology 2022-04, Vol.98 (15), p.e1545-e1554 |
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| creator | McElwee Decker, Barbara Thibault, Dylan Davis, Kathryn A Willis, Allison W |
| description | To compare maternal obstetric complications and nonelective readmissions in women with common neurologic comorbidities (WWN) vs women without neurologic disorders.
We performed a retrospective cohort study of index characteristics and acute postpartum, nonelective rehospitalizations from the 2015-2017 National Readmissions Database using ICD-10 codes. Wald χ
testing compared baseline demographic, hospital, and clinical characteristics and postpartum complications between WWN (including previous stroke, migraine, multiple sclerosis [MS], and myasthenia gravis [MG]) and controls. Multivariable logistic regression models examined odds of postpartum complications and nonelective readmissions within 30 and 90 days for each neurologic comorbidity compared to controls (α = 0.05).
A total of 7,612 women with previous stroke, 83,430 women with migraine, 6,760 women with MS, 843 women with MG, and 8,136,335 controls met the criteria for index admission after viable infant delivery. WWN were more likely than controls to have inpatient diagnoses of edema, proteinuria, or hypertensive disorders and to have received maternal care for poor fetal growth. The adjusted odds of a Centers for Disease Control and Prevention severe maternal morbidity indicator were greater for women with previous stroke (adjusted odds ratio [AOR] 8.53, 95% CI 7.24-10.06), migraine (AOR 2.04, 95% CI 1.85-2.26), and MG (AOR 4.45, 95% CI 2.45-8.08) (all
< 0.0001). Readmission rates at 30 and 90 days for WWN were higher than for controls (30 days: previous stroke 2.9%, migraine 1.7%, MS 1.8%, MG 4.3%, controls 1.1%; 90 days: previous stroke 3.7%, migraine 2.5%, MS 5.1%, MG 6.0%, controls 1.6%). Women with MG had the highest adjusted odds of readmission (30 days: AOR 3.96, 95% CI 2.37-6.65,
< 0.0001; 90 days: AOR 3.30, 95% CI 1.88-5.78,
< 0.0001).
WWN may be at higher risk of severe maternal morbidity at the time of index delivery and postpartum readmission. More real-world evidence is needed to develop research infrastructure and create efficacious interventions to optimize maternal-fetal outcomes in WWN, especially for women with previous stroke or MG. |
| doi_str_mv | 10.1212/WNL.0000000000200007 |
| format | Article |
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We performed a retrospective cohort study of index characteristics and acute postpartum, nonelective rehospitalizations from the 2015-2017 National Readmissions Database using ICD-10 codes. Wald χ
testing compared baseline demographic, hospital, and clinical characteristics and postpartum complications between WWN (including previous stroke, migraine, multiple sclerosis [MS], and myasthenia gravis [MG]) and controls. Multivariable logistic regression models examined odds of postpartum complications and nonelective readmissions within 30 and 90 days for each neurologic comorbidity compared to controls (α = 0.05).
A total of 7,612 women with previous stroke, 83,430 women with migraine, 6,760 women with MS, 843 women with MG, and 8,136,335 controls met the criteria for index admission after viable infant delivery. WWN were more likely than controls to have inpatient diagnoses of edema, proteinuria, or hypertensive disorders and to have received maternal care for poor fetal growth. The adjusted odds of a Centers for Disease Control and Prevention severe maternal morbidity indicator were greater for women with previous stroke (adjusted odds ratio [AOR] 8.53, 95% CI 7.24-10.06), migraine (AOR 2.04, 95% CI 1.85-2.26), and MG (AOR 4.45, 95% CI 2.45-8.08) (all
< 0.0001). Readmission rates at 30 and 90 days for WWN were higher than for controls (30 days: previous stroke 2.9%, migraine 1.7%, MS 1.8%, MG 4.3%, controls 1.1%; 90 days: previous stroke 3.7%, migraine 2.5%, MS 5.1%, MG 6.0%, controls 1.6%). Women with MG had the highest adjusted odds of readmission (30 days: AOR 3.96, 95% CI 2.37-6.65,
< 0.0001; 90 days: AOR 3.30, 95% CI 1.88-5.78,
< 0.0001).
WWN may be at higher risk of severe maternal morbidity at the time of index delivery and postpartum readmission. More real-world evidence is needed to develop research infrastructure and create efficacious interventions to optimize maternal-fetal outcomes in WWN, especially for women with previous stroke or MG.</description><identifier>ISSN: 0028-3878</identifier><identifier>EISSN: 1526-632X</identifier><identifier>DOI: 10.1212/WNL.0000000000200007</identifier><identifier>PMID: 35169012</identifier><language>eng</language><publisher>United States: American Academy of Neurology</publisher><subject>Female ; Humans ; Migraine Disorders - epidemiology ; Multiple Sclerosis - complications ; Multiple Sclerosis - epidemiology ; Myasthenia Gravis - epidemiology ; Patient Readmission ; Postpartum Period ; Pregnancy ; Pregnancy Complications - epidemiology ; Retrospective Studies ; Risk Factors ; Stroke - epidemiology</subject><ispartof>Neurology, 2022-04, Vol.98 (15), p.e1545-e1554</ispartof><rights>American Academy of Neurology</rights><rights>2022 American Academy of Neurology.</rights><rights>2022 American Academy of Neurology 2022 American Academy of Neurology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4536-f1e6343771bc3d6794b111664a279e43a1ff773ff14982f75aac192aa56c23653</citedby><cites>FETCH-LOGICAL-c4536-f1e6343771bc3d6794b111664a279e43a1ff773ff14982f75aac192aa56c23653</cites><orcidid>0000-0001-5724-7192 ; 0000-0002-7020-6480 ; 0000-0002-8084-7353</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35169012$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McElwee Decker, Barbara</creatorcontrib><creatorcontrib>Thibault, Dylan</creatorcontrib><creatorcontrib>Davis, Kathryn A</creatorcontrib><creatorcontrib>Willis, Allison W</creatorcontrib><title>Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis</title><title>Neurology</title><addtitle>Neurology</addtitle><description>To compare maternal obstetric complications and nonelective readmissions in women with common neurologic comorbidities (WWN) vs women without neurologic disorders.
We performed a retrospective cohort study of index characteristics and acute postpartum, nonelective rehospitalizations from the 2015-2017 National Readmissions Database using ICD-10 codes. Wald χ
testing compared baseline demographic, hospital, and clinical characteristics and postpartum complications between WWN (including previous stroke, migraine, multiple sclerosis [MS], and myasthenia gravis [MG]) and controls. Multivariable logistic regression models examined odds of postpartum complications and nonelective readmissions within 30 and 90 days for each neurologic comorbidity compared to controls (α = 0.05).
A total of 7,612 women with previous stroke, 83,430 women with migraine, 6,760 women with MS, 843 women with MG, and 8,136,335 controls met the criteria for index admission after viable infant delivery. WWN were more likely than controls to have inpatient diagnoses of edema, proteinuria, or hypertensive disorders and to have received maternal care for poor fetal growth. The adjusted odds of a Centers for Disease Control and Prevention severe maternal morbidity indicator were greater for women with previous stroke (adjusted odds ratio [AOR] 8.53, 95% CI 7.24-10.06), migraine (AOR 2.04, 95% CI 1.85-2.26), and MG (AOR 4.45, 95% CI 2.45-8.08) (all
< 0.0001). Readmission rates at 30 and 90 days for WWN were higher than for controls (30 days: previous stroke 2.9%, migraine 1.7%, MS 1.8%, MG 4.3%, controls 1.1%; 90 days: previous stroke 3.7%, migraine 2.5%, MS 5.1%, MG 6.0%, controls 1.6%). Women with MG had the highest adjusted odds of readmission (30 days: AOR 3.96, 95% CI 2.37-6.65,
< 0.0001; 90 days: AOR 3.30, 95% CI 1.88-5.78,
< 0.0001).
WWN may be at higher risk of severe maternal morbidity at the time of index delivery and postpartum readmission. More real-world evidence is needed to develop research infrastructure and create efficacious interventions to optimize maternal-fetal outcomes in WWN, especially for women with previous stroke or MG.</description><subject>Female</subject><subject>Humans</subject><subject>Migraine Disorders - epidemiology</subject><subject>Multiple Sclerosis - complications</subject><subject>Multiple Sclerosis - epidemiology</subject><subject>Myasthenia Gravis - epidemiology</subject><subject>Patient Readmission</subject><subject>Postpartum Period</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stroke - epidemiology</subject><issn>0028-3878</issn><issn>1526-632X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkc9u1DAQxiMEokvhDRDykUNTYjux4wsSVNAibUtFQeVmzSaTxtSJg-1stU_Aa9dL2-WPD2PLM9_Pnvmy7CUtDimj7M3l2fKw2C22DfJRtqAVE7ng7PvjbJGu65zXst7LnoXwoyhSUqqn2R6vqFAFZYvs17mbZgvRuDF_DwFbchHndkNcR87ciBabaNZIzl2IE_g4D-QLQjuYEJIiEDOSSzdgiib2SerdNR6QU3PlwYzb02yjmSySi8aid8GEAwJjS043EGKPowFy7GFtwvPsSQc24Iv7fT_79vHD16OTfPn5-NPRu2XelBUXeUdR8JJLSVcNb4VU5YpSKkQJqTEsOdCuk5J3HS1VzTpZATRUMYBKNIyLiu9nb--407wasG1wjB6snrwZwG-0A6P_zYym11durbfjYpIlwOt7gHc_ZwxRp2E0aC2M6OagmWCKS1VLlUrLu9ImdR48drtnaKG3Hurkof7fwyR79fcXd6IH0_5wb5yN6MO1nW_Q6x7Bxv43T1Ba5uqBmyvKCsFvAU2mqUA</recordid><startdate>20220412</startdate><enddate>20220412</enddate><creator>McElwee Decker, Barbara</creator><creator>Thibault, Dylan</creator><creator>Davis, Kathryn A</creator><creator>Willis, Allison W</creator><general>American Academy of Neurology</general><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5724-7192</orcidid><orcidid>https://orcid.org/0000-0002-7020-6480</orcidid><orcidid>https://orcid.org/0000-0002-8084-7353</orcidid></search><sort><creationdate>20220412</creationdate><title>Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis</title><author>McElwee Decker, Barbara ; Thibault, Dylan ; Davis, Kathryn A ; Willis, Allison W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4536-f1e6343771bc3d6794b111664a279e43a1ff773ff14982f75aac192aa56c23653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Female</topic><topic>Humans</topic><topic>Migraine Disorders - epidemiology</topic><topic>Multiple Sclerosis - complications</topic><topic>Multiple Sclerosis - epidemiology</topic><topic>Myasthenia Gravis - epidemiology</topic><topic>Patient Readmission</topic><topic>Postpartum Period</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stroke - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McElwee Decker, Barbara</creatorcontrib><creatorcontrib>Thibault, Dylan</creatorcontrib><creatorcontrib>Davis, Kathryn A</creatorcontrib><creatorcontrib>Willis, Allison W</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McElwee Decker, Barbara</au><au>Thibault, Dylan</au><au>Davis, Kathryn A</au><au>Willis, Allison W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis</atitle><jtitle>Neurology</jtitle><addtitle>Neurology</addtitle><date>2022-04-12</date><risdate>2022</risdate><volume>98</volume><issue>15</issue><spage>e1545</spage><epage>e1554</epage><pages>e1545-e1554</pages><issn>0028-3878</issn><eissn>1526-632X</eissn><abstract>To compare maternal obstetric complications and nonelective readmissions in women with common neurologic comorbidities (WWN) vs women without neurologic disorders.
We performed a retrospective cohort study of index characteristics and acute postpartum, nonelective rehospitalizations from the 2015-2017 National Readmissions Database using ICD-10 codes. Wald χ
testing compared baseline demographic, hospital, and clinical characteristics and postpartum complications between WWN (including previous stroke, migraine, multiple sclerosis [MS], and myasthenia gravis [MG]) and controls. Multivariable logistic regression models examined odds of postpartum complications and nonelective readmissions within 30 and 90 days for each neurologic comorbidity compared to controls (α = 0.05).
A total of 7,612 women with previous stroke, 83,430 women with migraine, 6,760 women with MS, 843 women with MG, and 8,136,335 controls met the criteria for index admission after viable infant delivery. WWN were more likely than controls to have inpatient diagnoses of edema, proteinuria, or hypertensive disorders and to have received maternal care for poor fetal growth. The adjusted odds of a Centers for Disease Control and Prevention severe maternal morbidity indicator were greater for women with previous stroke (adjusted odds ratio [AOR] 8.53, 95% CI 7.24-10.06), migraine (AOR 2.04, 95% CI 1.85-2.26), and MG (AOR 4.45, 95% CI 2.45-8.08) (all
< 0.0001). Readmission rates at 30 and 90 days for WWN were higher than for controls (30 days: previous stroke 2.9%, migraine 1.7%, MS 1.8%, MG 4.3%, controls 1.1%; 90 days: previous stroke 3.7%, migraine 2.5%, MS 5.1%, MG 6.0%, controls 1.6%). Women with MG had the highest adjusted odds of readmission (30 days: AOR 3.96, 95% CI 2.37-6.65,
< 0.0001; 90 days: AOR 3.30, 95% CI 1.88-5.78,
< 0.0001).
WWN may be at higher risk of severe maternal morbidity at the time of index delivery and postpartum readmission. More real-world evidence is needed to develop research infrastructure and create efficacious interventions to optimize maternal-fetal outcomes in WWN, especially for women with previous stroke or MG.</abstract><cop>United States</cop><pub>American Academy of Neurology</pub><pmid>35169012</pmid><doi>10.1212/WNL.0000000000200007</doi><orcidid>https://orcid.org/0000-0001-5724-7192</orcidid><orcidid>https://orcid.org/0000-0002-7020-6480</orcidid><orcidid>https://orcid.org/0000-0002-8084-7353</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0028-3878 |
| ispartof | Neurology, 2022-04, Vol.98 (15), p.e1545-e1554 |
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| language | eng |
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| source | MEDLINE; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Female Humans Migraine Disorders - epidemiology Multiple Sclerosis - complications Multiple Sclerosis - epidemiology Myasthenia Gravis - epidemiology Patient Readmission Postpartum Period Pregnancy Pregnancy Complications - epidemiology Retrospective Studies Risk Factors Stroke - epidemiology |
| title | Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis |
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