{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:56:47Z","timestamp":1792029407451,"version":"4.4.0"},"reference-count":62,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T00:00:00Z","timestamp":1697068800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000071","name":"National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["R15HD101793"],"award-info":[{"award-number":["R15HD101793"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To estimate the rate of acute health care use (hospitalizations and emergency department [ED] visits) among postpartum persons by rurality of residence and pregnancy complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources and Study Setting<\/jats:title><jats:p>2006\u20132021 data from the Maine Health Data Organization's All Payer Claims Data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We estimated the rates of hospitalizations and ED visits during the first 24\u2009months postpartum, separately, overall and by four\u2010level rurality of residence (urban, large rural, small rural, and isolated rural) and by pregnancy complications (prenatal depression, hypertensive disorders of pregnancy [HDP], and gestational diabetes mellitus [GDM]). We used Poisson regression models, adjusting for potential confounders. Data were weighted to account for censoring before 24\u2009months postpartum.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Extraction Methods<\/jats:title><jats:p>Deliveries during 2007\u20132019 (<jats:italic>n<\/jats:italic>\u2009=\u2009122,412).<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Approximately 4% of persons had at least one hospitalization within 24\u2009months postpartum (mean monthly rate per 100 deliveries\u2009=\u20090.35). Adjusted rates were not different by rurality. Persons with prenatal depression (adjusted rate ratio [aRR]\u2009=\u20091.9; 95% confidence interval [CI] 1.5\u20132.5), HDP (aRR\u2009=\u20091.4; 1.0\u20132.0), and GDM (aRR\u2009=\u20091.4; 0.9\u20132.0) had higher hospitalization rates than those without these conditions. Approximately 44% of persons had at least one ED visit within 24\u2009months postpartum (mean monthly rate per 100 deliveries\u2009=\u20095.4). Adjusted ED rates were higher for persons living in small rural areas as compared with urban areas (aRR\u2009=\u20091.3; 1.2\u20131.4). Persons with prenatal depression (aRR\u2009=\u20091.8; 1.7\u20131.9), HDP (aRR\u2009=\u20091.1; 1.0\u20131.2), and GDM (aRR\u2009=\u20091.3; 1.2\u20131.4) had higher ED rates than those without these conditions; ED rates were highest among those living in small rural areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>New policies and care practices may be needed to prevent acute health care encounters in the first 24\u2009months after delivery for persons with common pregnancy conditions. Efforts to identify why postpartum people living in small rural areas have higher rates of ED visits are warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.14247","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T23:48:43Z","timestamp":1697154523000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Acute health care utilization in the first 24\u2009months postpartum by rurality and pregnancy complications: A prospective cohort study"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5139-9208","authenticated-orcid":false,"given":"Katherine A.","family":"Ahrens","sequence":"first","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Palmsten","sequence":"additional","affiliation":[{"name":"Pregnancy and Child Health Research Center HealthPartners Institute  Bloomington Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlie O.","family":"Grantham","sequence":"additional","affiliation":[{"name":"Muskie School of Public Service University of Southern Maine  Portland Maine USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather S.","family":"Lipkind","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Weill Cornell Medical College  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina M.","family":"Ackerman\u2010Banks","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000004359"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/aog.0000000000002849"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.03.032"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1062860613487196"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995\u2010021\u201003282\u20105"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2016.01.174"},{"key":"e_1_2_11_8_1","volume-title":"Maternal Mortality in the United States: A Primer","author":"Declercq E","year":"2020"},{"key":"e_1_2_11_9_1","unstructured":"SMFM white paper: pregnancy as a window to future health. 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