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Abstract
Objective To compare maternal obstetric complications and nonelective readmissions in women with common neurologic comorbidities (WWN) vs women without neurologic disorders.
Methods 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 χ2 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).
Results 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 p < 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, p < 0.0001; 90 days: AOR 3.30, 95% CI 1.88–5.78, p < 0.0001).
Discussion 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.
Glossary
- AOR=
- adjusted odds ratio;
- CDC=
- Centers for Disease Control and Prevention;
- HCUP=
- Healthcare Cost and Utilization Project;
- ICD-10=
- International Classification of Diseases, Tenth Revision;
- ICD-10 CM/PCS=
- International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System;
- MG=
- myasthenia gravis;
- MS=
- multiple sclerosis;
- NRD=
- National Readmissions Database;
- SMM=
- severe maternal morbidity;
- WWN=
- women with neurologic comorbidities
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
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- Received June 1, 2021.
- Accepted in final form January 3, 2022.
- © 2022 American Academy of Neurology
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