Low income pregnant women who use emergency obstetric triage repetitively (four or more times) do so because of an unmet clinical and psychosocial need.

It is hoped these findings, which appeared online in the journal Women’s Health Issues, lead to innovative interventions that deliver care in a more coordinated effort to better support these women.

Individuals who are racial/ethnic minorities and of low socioeconomic status disproportionately experience poor pregnancy outcomes in the U.S. Prenatal care has been hypothesized to be a key mediator in perinatal outcome, particularly low birthweight, based on a key Institute of Medicine report. However, despite increased access to and utilization of prenatal care and growing expenditures on hospital–based obstetric care, maternal and neonatal health disparities are worsening over time.

To understand why existing Medicaid–funded prenatal care may be inadequate to address complex needs during pregnancy, researchers from BUSM and the Perelman School of Medicine at the University of Pennsylvania interviewed 40 Medicaid–insured pregnant women at the moment that they visited an emergency obstetric triage area. They recruited 20 women who were considered “high utilizers” during their pregnancy and 20 who had only been to the triage area once (“low utilizers”). Compared to low–utilizing women, high–utilizing women were more likely to report histories of childhood trauma and social isolation. During their pregnancy, both groups of women had difficulty accessing prenatal care, but high–utilizing women also frequently reported disorganized care, especially for complex illnesses. Most troublingly, high–utilizing women faced difficulty with basic needs like personal safety, housing and healthy food.

According to the researchers from the perspectives of these women, there are several steps that need to be taken to improve pregnancy care including expanding capacity and available appointments in prenatal clinics as well as improving provider continuity and quality in outpatient prenatal care. “It is also important that different hospitals and clinics have the ability to share medical records so that patients can go anywhere and their health information will be available,” explained corresponding author Pooja K. Mehta, MD, assistant professor of obstetrics and gynecology at BUSM.

The researchers encourage hospitals to partner with community–based services and home visiting organizations to improve the delivery of prenatal care outside the hospital. “We must recognize that high utilizing women face substantial challenges with social support, personal safety, housing, and food and work to address these needs to ensure a healthy pregnancy.”