Impact and factors affecting unplanned out-of-hospital birth on newborns at University Hospital compared to in-hospital born newborns

ABSTRACT Importance Unplanned out-of-hospital births have been associated with increased maternal and neonatal complications. Objective To determine factors that increase unplanned out-of-hospital births incidence and examine neonatal complications. Design Case-control study, January 2017 to December 2022. Setting Single-center Participants Unplanned out-of-hospital births coded under Z38.1 within the hospital database. A random sample of in-hospital births from the same time period served as control. Newborns with chromosomal and congenital abnormalities, stillbirths, and non-singleton births were excluded from analyses. Main Outcomes/Measures Maternal demographic risk factors for unplanned out-of-hospital births and neonatal complications and morbidity. Results 66 unplanned out-of-hospital births were compared with 72 in-hospital births. Newborns of unplanned out-of-hospital births were more likely to be affected by low birth weight (OR=5.90, 95%CI 1.87, 18.6), prematurity (OR=4.84, 95CI% 1.67, 14.1), and low gestational age compared to in-hospital newborns (p=4.13x10-3). Hypoglycemia (OR=38.0, 95%CI 4.95, 291), hypothermia (OR=35.5, 95% CI 4.62, 272), and bradycardia (OR=15.58, 95% CI 0.86, 282) were significantly associated with unplanned out-of-hospital births. Developmental delay, APGAR scores, and neonatal mortality were not significantly associated with birth location. Black/African-American mothers were significantly more likely to have unplanned out-of-hospital births (OR=4.29, 95%CI 2.10, 8.74). Mothers with unplanned out-of-hospital births were eight times as likely to have any substance-use-related ICD codes recorded (OR=7.98, 95%CI 2.22, 28.7) and less likely to receive appropriate prenatal care (OR=0.09, 95%CI 0.03, 0.26). Maternal parity, age at delivery, marital status, insurance, education, use of interpreting services, and employment status were not significantly associated with birth location. Conclusions and Relevance Findings suggest that mothers of Black/African-American race or substance-use-related diagnoses are more likely to have unplanned out-of-hospital births and less than appropriate prenatal care. Newborns of this group were more likely to be of low birth weight, low gestational age, and have hypoglycemia, hypothermia, and bradycardia. These findings emphasize the need for targeted interventions for at-risk populations to decrease the risk of preventable neonatal complications. KEY POINTS Question What are the maternal factors and neonatal outcomes associated with unplanned out-of-hospital births (UOHBs) in an urban, inner-city environment? Findings This study revealed significant associations to UOHBs that include insufficient prenatal care, substance use disorder, and demographic variables such as race/ethnicity. Newborn outcomes such as preterm births, low birth weight, hypoglycemia, hypothermia and bradycardia were significantly associated with UOHBs. Meaning These findings emphasize the need for targeted interventions for at-risk populations to decrease the risk of preventable neonatal complications.