J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 2, February 2017, pages 143-153

Epidemiology of Pregnancy-Associated ICU Utilization in Texas: 2001 - 2010

Figure 1. Categories of pregnancy-associated hospitalizations in Texas, 2001 - 2010. *There were 1,781 (0.04%) pregnancy-associated hospitalizations that could not be classified as either fetal loss or abortion.

**Table 1.** The Characteristics of Pregnancy-Associated ICU Admissions
Characteristic	n = 158,410
^aPercent figures are rounded. ^bAge groups were reported as < 17, 18 - 44, and ≥ 45 for 3,037 (1.9%) of ICU admissions with a diagnosis of human immunodeficiency virus infection, drug or alcohol abuse as additional means to preserve confidentiality in the data set. The denominator used to derive age group frequency for the cohort was based on hospitalizations with available 5-year age group designation (n = 155,373). ^cBased on comorbidities included in the Deyo-Charlson index. ^dThe figures for fetal loss and abortion do not include ICU 1,266 (0.8%) hospitalizations for which it could not be determined whether they involved fetal loss or abortion. HIV: human immunodeficiency virus.
Age (years, n (%))^{a, b}
< 18	7,481 (4.8)
18 - 34	124,898 (80.4)
≥ 35	22,994 (14.8)
Race/ethnicity, n (%)
Hispanic	53,491 (33.8)
White	60,525 (38.2)
Black	30,027 (19.0)
Other	14,327 (9.0)
Missing	40 (< 0.1)
Health insurance, n (%)
Private	73,075 (46.10)
Medicaid	71,179 (45.0)
Uninsured	10,465 (6.6)
Other	3,619 (2.3)
Missing	72 (< 0.1)
Select comorbidities, n (%)^c
Any	15,334 (9.7)
Lung disease	5,133 (3.2)
Connective tissue disease	836 (0.5)
Liver disease	735 (0.4)
Diabetes	4,625 (2.9)
Renal disease	628 (0.3)
Malignancy	321 (0.2)
HIV	120 (0.1)
Categories of pregnancy-associated hospitalizations, n (%)
Delivery	116,691 (73.7)
Antepartum	31,751 (20.0)
Postpartum	5,244 (3.3)
Fetal loss^d	3,009 (1.9)
Abortion^d	449 (0.3)
Organ dysfunction, n (%)
Any	9,769 (6.2)
≥ 3	449 (0.3)
APR-DRG severity of illness, n (%)
Mild	59,951 (37.8)
Moderate	56,373 (35.6)
High	36,312 (22.9)
Extreme	5,774 (3.6)
Hospital disposition, n (%)
Death	414 (0.3)
Hospice	24 (< 0.1)
Another facility	2,213 (1.4)
Home	154,656 (97.6)
Leave against medical advice	1,103 (0.7)

Table 1. The Characteristics of Pregnancy-Associated ICU Admissions

Characteristic

n = 158,410

^aPercent figures are rounded. ^bAge groups were reported as < 17, 18 - 44, and ≥ 45 for 3,037 (1.9%) of ICU admissions with a diagnosis of human immunodeficiency virus infection, drug or alcohol abuse as additional means to preserve confidentiality in the data set. The denominator used to derive age group frequency for the cohort was based on hospitalizations with available 5-year age group designation (n = 155,373). ^cBased on comorbidities included in the Deyo-Charlson index. ^dThe figures for fetal loss and abortion do not include ICU 1,266 (0.8%) hospitalizations for which it could not be determined whether they involved fetal loss or abortion. HIV: human immunodeficiency virus.

Age (years, n (%))^{a, b}

< 18

7,481 (4.8)

18 - 34

124,898 (80.4)

≥ 35

22,994 (14.8)

Race/ethnicity, n (%)

Hispanic

53,491 (33.8)

White

60,525 (38.2)

Black

30,027 (19.0)

Other

14,327 (9.0)

Missing

40 (< 0.1)

Health insurance, n (%)

Private

73,075 (46.10)

Medicaid

71,179 (45.0)

Uninsured

10,465 (6.6)

Other

3,619 (2.3)

Missing

72 (< 0.1)

Select comorbidities, n (%)^c

Any

15,334 (9.7)

Lung disease

5,133 (3.2)

Connective tissue disease

836 (0.5)

Liver disease

735 (0.4)

Diabetes

4,625 (2.9)

Renal disease

628 (0.3)

Malignancy

321 (0.2)

HIV

120 (0.1)

Categories of pregnancy-associated hospitalizations, n (%)

Delivery

116,691 (73.7)

Antepartum

31,751 (20.0)

Postpartum

5,244 (3.3)

Fetal loss^d

3,009 (1.9)

Abortion^d

449 (0.3)

Organ dysfunction, n (%)

Any

9,769 (6.2)

≥ 3

449 (0.3)

APR-DRG severity of illness, n (%)

Mild

59,951 (37.8)

Moderate

56,373 (35.6)

High

36,312 (22.9)

Extreme

5,774 (3.6)

Hospital disposition, n (%)

Death

414 (0.3)

Hospice

24 (< 0.1)

Another facility

2,213 (1.4)

Home

154,656 (97.6)

Leave against medical advice

1,103 (0.7)

**Table 2.** The Incidence of Pregnancy-Associated ICU Admissions
Category of ICU admissions	Denominator	Incidence per 1,000^a	2010 vs. 2010 (%)^b	AAPC (95% CI)	P
^aIncidence estimates are per 1,000 of a given denominator-years (i.e., per 1,000 live births-years). ^bRefers to the relative difference. AAPC: average annual percent change; 95% CI: 95% confidence intervals. ^cTEP: total estimated pregnancies.
From state population
All	TEP^c	29.6	63.9	+5.0 (3.8 to 6.2)	< 0.0001
Live births	Live births	29.6	71.9	+5.2 (4.1 to 6.6)	< 0.0001
Stillbirths	Stillbirths	85.9	95.4	+5.2 (2.6 to 7.8)	0.0015
Fetal loss	Fetal loss	4.3	13.2	+2.1 (-2.4 to +4.6)	0.0867
Abortion	Abortion	0.6	-47.1	-4.4 (-7.9 to -0.8)	0.0214
From pregnancy-associated hospitalizations
All	All	39.0	68.0	+5.2 (4.0 to 6.3)	< 0.0001
All	Delivery	43.6	67.1	+5.1 (4.0 to 6.2)	< 0.0001
Delivery	Delivery	32.1	70.3	+5.3 (4.0 to 6.6)	< 0.0001
Antepartum	Delivery	8.7	53.0	+4.1 (2.0 to 6.2)	0.0020
Postpartum	Delivery	1.4	123.0	+7.8 (6.0 to 9.6)	< 0.0001
Antepartum	Antepartum	99.2	59.4	+4.8 (3.3 to 6.3)	0.0001
Postpartum	Postpartum	144.8	63.8	+5.0 (3.9 to 6.1)	< 0.0001
Fetal loss	Fetal loss	48.7	75.2	+5.8 (4.2 to 7.4)	< 0.0001
Abortion	Abortion	79.6	-17.3	+0.1 (-3.4 to +3.7)	0.9280

Table 2. The Incidence of Pregnancy-Associated ICU Admissions

Category of ICU admissions

Denominator

Incidence per 1,000^a

2010 vs. 2010 (%)^b

AAPC (95% CI)

^aIncidence estimates are per 1,000 of a given denominator-years (i.e., per 1,000 live births-years). ^bRefers to the relative difference. AAPC: average annual percent change; 95% CI: 95% confidence intervals. ^cTEP: total estimated pregnancies.

From state population

All

TEP^c

29.6

63.9

+5.0 (3.8 to 6.2)

< 0.0001

Live births

29.6

71.9

+5.2 (4.1 to 6.6)

< 0.0001

Stillbirths

85.9

95.4

+5.2 (2.6 to 7.8)

0.0015

Fetal loss

4.3

13.2

+2.1 (-2.4 to +4.6)

0.0867

Abortion

0.6

-47.1

-4.4 (-7.9 to -0.8)

0.0214

From pregnancy-associated hospitalizations

All

39.0

68.0

+5.2 (4.0 to 6.3)

< 0.0001

All

Delivery

43.6

67.1

+5.1 (4.0 to 6.2)

< 0.0001

Delivery

32.1

70.3

+5.3 (4.0 to 6.6)

< 0.0001

Antepartum

Delivery

8.7

53.0

+4.1 (2.0 to 6.2)

0.0020

Postpartum

Delivery

1.4

123.0

+7.8 (6.0 to 9.6)

< 0.0001

Antepartum

99.2

59.4

+4.8 (3.3 to 6.3)

0.0001

Postpartum

144.8

63.8

+5.0 (3.9 to 6.1)

< 0.0001

Fetal loss

48.7

75.2

+5.8 (4.2 to 7.4)

< 0.0001

Abortion

79.6

-17.3

+0.1 (-3.4 to +3.7)

0.9280

**Table 3.** Occurrence of Maternal Complications and Organ Dysfunctions Among ICU Admissions (n = 158,410) and Corresponding Rates of ICU Admission Among Pregnancy-Associated Hospitalizations
Category	Occurrence among ICU admissions (n (%))	Rate of ICU admission (%)^a
^aRate of ICU admission among all pregnancy-associated hospitalizations with a specific maternal complication or organ dysfunction.
Maternal complications
Preeclampsia/eclampsia	36,978 (23.3)	12.0
Hemorrhage	11,005 (6.9)	8.9
Embolism	1,020 (0.6)	51.0
Cardiovascular conditions	9,603 (6.1)	15.2
Cardiomyopathy	2,740 (1.7)	63.5
Cerebrovascular accident	1,049 (0.7)	48.0
Sepsis	1,746 (1.1)	51.3
Aspiration pneumonia	583 (0.4)	40.3
Trauma	1,273 (0.8)	15.5
Anesthesia complications	139 (0.1)	22.6
Hyperemesis	2,120 (1.3)	5.0
Status asthmaticus	154 (0.1)	25.0
Status epilepticus	80 (< 0.1)	65.6
Blood transfusion complication	68 (< 0.1)	22.2
Organ dysfunction
Respiratory	4,470 (2.8)	73.5
Cardiovascular	1,815 (1.1)	40.3
Renal	1,051	64.9
Hepatic	203 (0.1)	70.2
Hematological	3,933 (2.5)	15.6
Metabolic	968 (0.6)	58.4
Neurological	572 (0.4)	61.1

Table 3. Occurrence of Maternal Complications and Organ Dysfunctions Among ICU Admissions (n = 158,410) and Corresponding Rates of ICU Admission Among Pregnancy-Associated Hospitalizations