Changes in the Prevalence of Pregnancy Complications During the COVID-19 Pandemic: Is Increased Prevalence the New Normal?
Author(s)
Elizabeth Packnett, MPH, Liisa A Palmer, PhD;
Merative, Ann Arbor, MI, USA
Merative, Ann Arbor, MI, USA
OBJECTIVES: Many changes in healthcare resource utilization, morbidity, and mortality have been attributed to the emergence of COVID-19 and the COVID-19 pandemic. This study’s objective was to characterize changes in the prevalence pregnancy complications during the COVID-19 pandemic in the United States.
METHODS: Pregnancies ending between January 1, 2018 and December 31, 2023 with a live birth or stillbirth outcome were identified in the MarketScan Commercial and Multi-State Medicaid Databases. Pregnancies were restricted to patients aged 15-50 and female sex on the pregnancy end date and were required to have 140 days of continuous enrollment prior to the pregnancy end date. Presence gestational diabetes, placental complications, pre-eclampsia/eclampsia, and/or hemorrhage were assessed using diagnosis code on non-rule out medical claims during the relevant etiologic window for each outcome. Prevalence of each outcome was calculated by calendar year as the percent of pregnancies that ended during the calendar year with each outcome.
RESULTS: 1,132,060 Commercially-insured pregnancies and 1,061,212 Medicaid-insured pregnancies were included in this analysis. In both populations, most pregnancies were in patients aged 18-34 (74.2% Commercial; 87.6% Medicaid). Year to year increases in all pregnancy complications were observed during the study period in both Commercial and Medicaid insured pregnancies. A 42.7% increase in pre-eclampsia/eclampsia was observed in the Commercial population and a 37.3% increase was observed in the Medicaid population during the study period. Hemorrhage increased 39.5% in Commercial and 21.9% in Medicaid, placental complications increased 27.4% in Commercial and 17.4% in Medicaid, and gestational diabetes increased 20.5% in Commercial and 13.5% in Medicaid during the study period.
CONCLUSIONS: Pregnancy complications have increased during the COVID-19 pandemic in both Commercially-insured and Medicaid-insured pregnancies. In 2023, the prevalence of pregnancy complications remained elevated relative to the period prior to the COVID-19 pandemic in the United States.
METHODS: Pregnancies ending between January 1, 2018 and December 31, 2023 with a live birth or stillbirth outcome were identified in the MarketScan Commercial and Multi-State Medicaid Databases. Pregnancies were restricted to patients aged 15-50 and female sex on the pregnancy end date and were required to have 140 days of continuous enrollment prior to the pregnancy end date. Presence gestational diabetes, placental complications, pre-eclampsia/eclampsia, and/or hemorrhage were assessed using diagnosis code on non-rule out medical claims during the relevant etiologic window for each outcome. Prevalence of each outcome was calculated by calendar year as the percent of pregnancies that ended during the calendar year with each outcome.
RESULTS: 1,132,060 Commercially-insured pregnancies and 1,061,212 Medicaid-insured pregnancies were included in this analysis. In both populations, most pregnancies were in patients aged 18-34 (74.2% Commercial; 87.6% Medicaid). Year to year increases in all pregnancy complications were observed during the study period in both Commercial and Medicaid insured pregnancies. A 42.7% increase in pre-eclampsia/eclampsia was observed in the Commercial population and a 37.3% increase was observed in the Medicaid population during the study period. Hemorrhage increased 39.5% in Commercial and 21.9% in Medicaid, placental complications increased 27.4% in Commercial and 17.4% in Medicaid, and gestational diabetes increased 20.5% in Commercial and 13.5% in Medicaid during the study period.
CONCLUSIONS: Pregnancy complications have increased during the COVID-19 pandemic in both Commercially-insured and Medicaid-insured pregnancies. In 2023, the prevalence of pregnancy complications remained elevated relative to the period prior to the COVID-19 pandemic in the United States.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH128
Topic
Epidemiology & Public Health
Disease
SDC: Reproductive & Sexual Health