392 - Investigation of Prenatal Maternal Diagnosis Codes in Relation to Poor Birth Outcomes In Kentucky Using Medicaid Claims Data

Publication Number: 392.5930

Aric Schadler, University of Kentucky Healthcare, Lexington, KY, United States; Brenten T. Porter, University of Kentucky College of Medicine, Lexington, KY, United States; John M. O'Brien, University of Kentucky, Lexington, KY, United States; Peter J.. Giannone, University of Kentucky, Lexington, KY, United States; Mina Hanna, University of Kentucky - - Lexington, KY, Lexington, KY, United States; Hong Huang, University of Kentucky, Lexington, KY, United States; John A. Bauer, University of Kentucky College of Medicine, Lexington, KY, United States

Background: Premature birth is a major medical problem and rates vary by state and city. In 2022, 11.7% of live births in Kentucky were premature, which is above the national average. Many perinatal factors contribute to prematurity occurrence and the derived outcomes. Better understanding of linkages of maternal health status and birth outcomes could provide opportunities for improved care in our region.

Objective: Utilize statewide Medicaid claims data for Kentucky and related Maternal ICD10 codes from births 2017-2021; including maternal ICD10 codes/claims for 1yr prior to birth. Relate prenatal maternal ICD10 codes to birth outcomes and neonatal status in the first 180 days of postnatal life.

Design/Methods: A total of 189,000 births were reviewed, wherein maternal ICD10 codes during prenatal year were investigated in relation to birth outcomes. Comparisons of maternal conditions in cases of term (37+wks gestation), preterm ( < 37wks), and extremely preterm births ( < 28wks) were conducted. Maternal prenatal substance use, hemodynamic status, obesity and metabolic status, and infection status were investigated as prenatal domains of influence regarding birth outcomes. Parametric and nonparametric tests were used as appropriate. An alpha-level of 0.05 was used to determine significance.

Results: Maternal prenatal nicotine, alcohol, or illicit drug use increased odds of preterm birth by ~1.6 fold and extreme prematurity by ~2.0 fold. Perinatal hemodynamic conditions (pre-existing hypertension, gestational hypertension, preeclampsia) increased prematurity or extreme prematurity risks 2.5-5.0 fold. Premature membrane rupture and COVID diagnosis was also predictive of preterm birth (5.7 and 1.3-fold risk respectively).

Conclusion(s): These findings illustrate that Medicaid claims can be used to identify variables for use in predictive modeling of birth outcomes, and support the concepts of substance use, hemodynamics, metabolic status, and infection status can be used as prenatal risk domains for stratifying early birth risks. Further investigation of such approaches are clearly warranted.

Maternal Drivers in Premature versus Term Births


Maternal Drivers in Extreme Premature versus Term Births