Population-Based Trends in Emergency Department Visits During Pregnancy

Emergency departments frequently absorb contractions in access to healthcare services, as seen with increases in ED volumes following hospital closures. Although obstetric care access in the United States is decreasing, national trends in pregnancy-related ED encounters has not been well characterized. We therefore evaluated population-based trends in ED utilization among pregnant and non-pregnant reproductive-age individuals.

We conducted a retrospective population-based analysis of ED visit rates among females aged 15–49 years using the National Emergency Department Sample from 2007–2020. Pregnancy-related encounters were identified using diagnosis and procedure codes and stratified by patient residential urban–rural designation. Annual age-adjusted ED visit rates were calculated using dataset survey design elements, Census Bureau population estimates, and National Center for Health Statistics natality data. Temporal trends were evaluated using Joinpoint regression with log-linear models to estimate annual percent change (APC). Pairwise coincidence and parallelism tests assessed differences in trajectories and rates of presentation.

The sample included 108.2 million ED encounters among reproductive-age females, representing 473.8 million weighted visits nationally, with 9.6% being pregnancy-related. Most encounters involved residents of large central metropolitan counties (28.7%). Baseline ED visit rates were 689.8 per 1,000 pregnant individuals and 438.3 per 1,000 non-pregnant individuals. Rates peaked at 1,147.7 per 1,000 pregnant individuals in 2019 and 502.6 per 1,000 non-pregnant individuals in 2017. ED utilization increased more among pregnant patients (APC 4.58%, 95% CI 4.13–5.03) than non-pregnant patients (APC 1.07%, 95% CI 0.34–1.80). Across all urban-rural strata, increases were greater among pregnant patients. Trajectories and rates of change differed significantly in all comparisons.

From 2007–2020, ED utilization during pregnancy increased substantially, nearly doubling, at rates 4-fold greater than non-pregnant individuals. These findings underscore the expanding role of EDs in pregnancy care, highlighting the need for improved ED preparedness related to the management of obstetric presentation and the characterization of systemic factors contributing to these trends.