{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:52:50Z","timestamp":1786978370534,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T00:00:00Z","timestamp":1761523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005561","name":"North Carolina Department of Health and Human Services","doi-asserted-by":"publisher","award":["#30\u20102019\u2010020\u2010DHB"],"award-info":[{"award-number":["#30\u20102019\u2010020\u2010DHB"]}],"id":[{"id":"10.13039\/100005561","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We sought to describe characteristics of pregnant Medicaid beneficiaries seeking emergency care in early pregnancy and to identify risk factors, specifically social drivers of health (SDOH), for emergency care use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Linked Medicaid hospital claims, live birth records, and North Carolina Pregnancy Risk Screening Form data were used to identify risk factors for emergency care use among pregnancies resulting in a live birth between January 2014 and December 2019. Emergency care use included visits to the emergency department or obstetric triage unit that occurred in pregnancy prior to 20 weeks\u2019 gestation. Demographic characteristics, SDOH, medical comorbidities, and pregnancy characteristics were assessed by the number of emergency care visits that occurred\u00a0&lt;20 weeks\u2019 gestation. Multivariable ordered logistic regression modeled the association between potential SDOH risk factors for emergency care use and the number of emergency care visits (0, 1, 2, \u22653), adjusting for age, medical comorbidities, and pregnancy characteristics. Models were expressed as odds ratio (OR) with 95% confidence intervals (CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 70,669 (50.4%) pregnancies among North Carolina Medicaid beneficiaries had at least one emergency care visit prior to 20 weeks\u2019 gestation; 36,327 (51.4%) had only 1 emergency care visit, 18,078 (25.6%) had 2 emergency care visits, and 16,264 (23.0%) had \u22653 emergency care visits. Compared to those with no emergency care use, those with any emergency care use prior to 20 weeks\u2019 gestation more frequently identified as Black, were \u226435 years old, experienced physical violence or intimate partner violence within the past year, reported unstable living, food insecurity, and had a parent, friend, or partner with substance use disorder. In multivariable models, several SDOH were associated with increased odds of emergency care use before 20 weeks\u2019 gestation, including having a high school education or less (OR, 1.23; 95% CI, 1.18\u20131.29), experience of physical violence within the last year (OR, 1.54; 95% CI, 1.45\u20131.64), food insecurity (OR, 1.20; 95% CI, 1.13\u20131.26), and housing instability (OR, 1.25; 95% CI, 1.17\u20131.34).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Half of pregnant Medicaid beneficiaries in North Carolina had\u00a0\u22651 emergency care visit prior to 20 weeks\u2019 gestation. Given the association between several SDOH and increased odds of emergency care use, early emergency care use in pregnancy may signal social and economic needs and opportunities for targeted intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70132","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T07:21:42Z","timestamp":1761549702000},"source":"Crossref","is-referenced-by-count":1,"title":["Emergency care use in early pregnancy among North Carolina Medicaid beneficiaries"],"prefix":"10.1002","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0400-0177","authenticated-orcid":false,"given":"Emma","family":"Trawick Roberts","sequence":"first","affiliation":[{"name":"Division of Maternal Fetal Medicine, School of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Kucirka","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, School of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"School of Data Science and Society University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara E.","family":"Busse","sequence":"additional","affiliation":[{"name":"Division of Health Policy and Management University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Kathryn","family":"Menard","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, School of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine J.","family":"Vladutiu","sequence":"additional","affiliation":[{"name":"Division of Maternal Fetal Medicine, School of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Weiss A.andH.KJiang.2021.Most Frequent Reasons for Emergency Department Visits 2018. HCUP Statistical Brief #286. December 2021.https:\/\/hcup-us.ahrq.gov\/reports\/statbriefs\/sb286-ED-Frequent-Conditions-2018.pdf."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2007.11.011"},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","unstructured":"Cairns C.andK.Kang.2023.National Hospital Ambulatory Medical Care Survey: 2021 Emergency Department Summary Tables.National Center for Health Statistics Centers for Disease Control and Prevention.https:\/\/www.cdc.gov\/nchs\/data\/nhamcs\/web_tables\/2021-nhamcs-ed-web-tables-508.pdf.","DOI":"10.15620\/cdc:115748"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2017.06.020"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.focus.2023.100142"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.05.040"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.29532"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100461"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.10.013"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2005.12.030"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.92.5.778"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2013.05.007"},{"key":"e_1_2_7_14_1","unstructured":"2019 Resident Live Births North Carolina.N.C. DHHS Division of Public Health State Center for Health Statistics. Accessed March 31 2025.https:\/\/schs.dph.ncdhhs.gov\/data\/births\/2019.htm."},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010018\u20102651\u20106"},{"key":"e_1_2_7_16_1","unstructured":"Pregnancy Medical Home.NC Medicaid Division of Health Benefits North Carolina Department of Health and Human Services. Accessed March 7 2025 https:\/\/medicaid.ncdhhs.gov\/providers\/programs\u2010and\u2010services\/family\u2010planning\u2010and\u2010maternity\/pregnancy\u2010medical\u2010home."},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.404"},{"key":"e_1_2_7_18_1","unstructured":"Basic Medicaid Eligibility Chart.North Carolina Medicaid Division of Health Benefits North Carolina Department of Health and Human Services. Accessed July 1 2025 https:\/\/medicaid.ncdhhs.gov\/documents\/files\/basic\u2010medicaid\u2010eligibility\u2010chart\u20102019\u20100."},{"key":"e_1_2_7_19_1","unstructured":"North Carolina Department of Health and Human Services Division of Medical Assistance.2018.DMA Administrative Letter No. 03\u201018: Hospital Provider Instructions for Determining Presumptive Eligibility.Raleigh NC:NCDHHS. Accessed March 31 2025.https:\/\/medicaid.ncdhhs.gov\/documents\/county\/ma-al03-18\/download."},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2024.0180"},{"key":"e_1_2_7_21_1","unstructured":"Emergency Department and Inpatient Utilization and Cost for Pregnant Women: Variation by Expected Primary Payer and State of Residence 2019. Healthcare Cost and Utilization Project. December 14 2021. Accessed March 31 2025.https:\/\/hcup-us.ahrq.gov\/reports\/ataglance\/HCUPanalysisHospUtilPregnancy.pdf."},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13215"},{"key":"e_1_2_7_23_1","unstructured":"US Census Bureau. American Community Survey 2018\u20132022. Accessed March 31 2025.https:\/\/data.census.gov\/table?q=DP02&g=040XX00US37."},{"key":"e_1_2_7_24_1","unstructured":"Questions and Answers About Medicaid Expansion.NC Medicaid Division of Health Benefits North Carolina Department of Health and Human Services. Accessed March 7 2024 https:\/\/medicaid.ncdhhs.gov\/questions\u2010and\u2010answers\u2010about\u2010medicaid\u2010expansion#:~:text=Undocumented%2C%20non%2DU.S%20citizen%20pregnant to%20receive%20full%20Medicaid%20benefits."},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010021\u201003232\u20101"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13060"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.2412"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0000000000001671"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0000000000001261"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco\u20102016\u2010000024"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.18043\/ncm.81.1.51"}],"container-title":["Pregnancy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmf2.70132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T02:29:34Z","timestamp":1764815374000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/pmf2.70132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,27]]},"references-count":30,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1002\/pmf2.70132"],"URL":"https:\/\/doi.org\/10.1002\/pmf2.70132","archive":["Portico"],"relation":{},"ISSN":["2997-9684","2997-9684"],"issn-type":[{"value":"2997-9684","type":"print"},{"value":"2997-9684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,27]]},"article-number":"e70132"}}