Rates of ICU Admission Among Peripartum Women With Obesity at Urban and Rural Hospitals in the [40Q

Abstract

INTRODUCTION: Women with obesity, particularly BMI ≥ 50 kg/m2, have increased risk of peripartum admission to the intensive care unit (ICU). We sought to investigate whether the rate of peripartum ICU admission for women with obesity varied by location of birth (rural versus urban). METHODS: We used 2014-2015 geocoded birth records from the National Center for Health Statistics (NCHS) to examine the rural-urban differences in ICU admission among nulliparous women delivering singleton, vertex pregnancies at term. The rates of ICU admission were assessed by geographic category (NCHS urban-rural classification) of the county of delivery. BMI was classified into eight total groups defined by WHO criteria with sub-stratification of class III obesity every 5 kg/m2 up to BMI ≥50 kg/m2. RESULTS: Among 2,538,994 eligible births, the overall rate of ICU admission per 1000 live births was higher for women with BMI ≥50 kg/m2 (RR 3.89, 95% CI 2.20-6.90) across all geographic categories. Compared to large metropolitan-central counties, rates of ICU admission were lower for all other counties except non-core, which had a higher ICU admission rate (RR 1.72, 95% 1.24-2.39). When evaluating the interaction of BMI and geography, the rate of ICU admission did not vary by BMI or geography except for an increased rate of ICU admission for women with BMI between 30 and 34.9 kg/m2 delivering in micropolitan areas (RR 1.81, 95% CI 1.14-2.86). CONCLUSION: The rate of ICU admission is similar across geographic locations and BMI strata. Whether this rate should be lower in rural areas warrants further investigation.