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April 12, 2022; 98 (15) Research Article

Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis

View ORCID ProfileBarbara M. Decker, Dylan Thibault, View ORCID ProfileKathryn A. Davis, View ORCID ProfileAllison W. Willis
First published February 15, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200007
Barbara M. Decker
From the Department of Neurology (B.M.D., K.A.D., A.W.W.), Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (B.M.D., D.T., A.W.W.), Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, School of Medicine (B.M.D., D.T., A.W.W.), and Leonard Davis Institute of Health Economics (B.M.D., A.W.W.), University of Pennsylvania, Philadelphia; and Department of Neurological Sciences (B.M.D.), University of Vermont Medical Center, Burlington.
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  • ORCID record for Barbara M. Decker
Dylan Thibault
From the Department of Neurology (B.M.D., K.A.D., A.W.W.), Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (B.M.D., D.T., A.W.W.), Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, School of Medicine (B.M.D., D.T., A.W.W.), and Leonard Davis Institute of Health Economics (B.M.D., A.W.W.), University of Pennsylvania, Philadelphia; and Department of Neurological Sciences (B.M.D.), University of Vermont Medical Center, Burlington.
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Kathryn A. Davis
From the Department of Neurology (B.M.D., K.A.D., A.W.W.), Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (B.M.D., D.T., A.W.W.), Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, School of Medicine (B.M.D., D.T., A.W.W.), and Leonard Davis Institute of Health Economics (B.M.D., A.W.W.), University of Pennsylvania, Philadelphia; and Department of Neurological Sciences (B.M.D.), University of Vermont Medical Center, Burlington.
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  • ORCID record for Kathryn A. Davis
Allison W. Willis
From the Department of Neurology (B.M.D., K.A.D., A.W.W.), Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics (B.M.D., D.T., A.W.W.), Department of Neurology, Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, School of Medicine (B.M.D., D.T., A.W.W.), and Leonard Davis Institute of Health Economics (B.M.D., A.W.W.), University of Pennsylvania, Philadelphia; and Department of Neurological Sciences (B.M.D.), University of Vermont Medical Center, Burlington.
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  • ORCID record for Allison W. Willis
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Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis
Barbara M. Decker, Dylan Thibault, Kathryn A. Davis, Allison W. Willis
Neurology Apr 2022, 98 (15) e1545-e1554; DOI: 10.1212/WNL.0000000000200007

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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.

  • Infographic: links.lww.com/WNL/B881

  • CME Course: NPub.org/cmelist

  • Podcast: NPub.org/Podcast9815

  • Received June 1, 2021.
  • Accepted in final form January 3, 2022.
  • © 2022 American Academy of Neurology
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  • Reader Response: Population-Based Study of Nonelective Postpartum Readmissions in Women With Stroke, Migraine, Multiple Sclerosis, and Myasthenia Gravis
    • Sanjuktha Saiba, Medical Student, Cooper Medical School of Rowan University
    • James E. Siegler, Neurologist, Cooper University Hospital
    Submitted September 22, 2022
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