Theoverarchinggoalofthisproposalistoexpandknowledgeofhealthrisksofwomenwhohaveastillbirth, specificallybyinvestigatingpostpartumhospitalreadmissions.Stillbirthisdefinedasdeliveryatorafter20 weeks?gestationofaninfantwhodiedinutero.Itisoneofthemostdevastatingoutcomesaffectingpregnant women.Evidencesuggeststhatrelativetowomenwhohavealivebirth,womenwhohaveastillbirthmaybe atincreasedriskofadversehealthoutcomesnotjustatdeliverybutalsopostpartum.Veryfewstudieshave examinedmaternalmorbidityafterstillbirth,theoneexceptionbeingmentalhealthproblems,suchas depression.Thisproposalfocusesonaspecificaspectofmaternalhealthafterstillbirth?postpartumhospital readmission?asakeyindicatorforthemostseverematernalmorbiditythatoccursafterstillbirth.Weare unawareofanypriorlarge-scalestudiesofhospitalreadmissionafterstillbirth.Ourobjectiveistodetermine theincidence,indicationsandpredictorsofhospitalreadmissionafterstillbirth.Wewilluseauniquedataset thatincludes35,000stillbirthsfromacohortof8millionbirthsfrom1998-2012inCalifornia,whichrepresents1 in8U.S.births.Eachbirthyearincludesdatafrombirthandfetaldeathcertificateslinkedwithmaternal hospitaldischargerecords.
Our SpecificAims areasfollows.
Aim1 :Determinetheincidenceofand indicationsforpostpartumhospitalreadmissionupto1yearafterdeliveryamongwomenwhohadastillbirth. Thiswillincludeaninvestigationofwhethertheseoutcomesaredifferentamongwomenwhohadalivebirth, andwhetherthemostcommonindicationsforhospitalizationvarybasedontimefromdelivery(e.g.,<42days versuslater).Ourhypothesesarethatincidenceofreadmissionishigheramongwomenwhohadastillbirth versuslivebirth,andthatthemostcommonindicationsforreadmissionvaryasthefirstyearpostpartum progresses.
Aim2 :Identifyriskfactorsforpostpartumreadmissionamongwomenwhohadastillbirth.Wewill examinesociodemographicfactors(e.g.,race/ethnicity,education,parity),pregnancy-anddelivery-related factors(e.g.,maternalmorbidities,gestationalageatdelivery,modeofdelivery),andhospitalcharacteristics (e.g.,obstetricvolume).Ourhypothesisisthatacombinationofpatient-andhospital-levelfactorsinfluence theriskofmaternalreadmissionafterstillbirth.Wewillprimarilyusesurvivalanalysistechniquestoaddress bothAims.Ourproposalisinnovativeinthatitrepresentsashiftforresearchonstillbirth?mostresearch focusesonitsimmediatecauses,whereasweproposetofocusonitsconsequencesforthemother.Insum, ouruniquestudyquestions,data,andrigorousanalyticapproacheswillenableustosubstantiallyadvance currentunderstandingoftheimpactofstillbirthonmaternalhealthandmakesubstantialstridestoward understandinghowbesttominimizetheadverseimpactsofthisunfortunateoutcome.Ourfindingswillpave thewayforthedevelopmentofareliablesystemforimprovingthepostpartumcare,counseling,and, ultimately,thehealthofthispotentiallyhigh-riskgroupofwomen.
Theproposedresearchwillexaminetheincidence,indications,andriskfactorsforhospital readmissionintheyearafterdelivery,amongwomenwhohavehadastillbirth.Thenew knowledgegeneratedbythisresearchwillpavethewayforimprovingpostpartumcare, counseling,and,ultimately,thehealthofwomenwhoexperiencestillbirth.
