The Impact of Maternal and Neonatal Intensive Care Unit Utilization on Maternal and Neonatal Health Outcomes in High-Risk Pregnancies

Abstract

Background: South Korea is facing a decline in birth rates and a rising number of high-risk pregnancies due to rising in late pregnancies. In 2022, the number of births decreased by 30.4% compared to 2017, while the proportion of mothers aged 35 and older increased to 39.3%. This shift is linked to higher risks of complications such as infertility, miscarriage, and the need for obstetric interventions. Additionally, high-risk deliveries, including preterm births, low birth weight, and multiple births, are on the rise, placing greater demand on specialized care. In the face of these challenges, The government's efforts to address these issues include the establishment of regional integrated care centers for high-risk pregnancies and neonates since 2014. The Ministry of Health and Welfare has introduced policies to support high-risk pregnancies, including management fees and hospitalization fees for voluntary treatment. However, with the increasing number of high-risk pregnancies and decreasing birth rates, continuous development of Maternal-Fetal Intensive Care Units (MFICUs) is crucial for improving maternal and neonatal health outcomes. However, studies evaluating the related effects are scarce. Therefore, this study aims to explore the association between MFICU and Postpartum Maternal Morbidity. Methods: This population-based cohort study used data from the National Health Insurance Service cohort database, spanning from 2011 to 2023, to investigate the relationship between MFICU admission and postpartum maternal morbidity (PMM). Propensity score matching (1:2 ratio) was applied based on maternal age, year of delivery, pregnancy-related complications, income, mode of delivery, and other factors to minimize confounding. The study focused on 21,934 pregnant women, of whom 7,962 were admitted to the MFICU and 13,972 were not. The primary independent variable was the admission status of high-risk pregnant women to the MFICU, with the dependent variable being PMM, defined as occurrences such as sepsis, uterine hysterectomy, ICU admission, death, stillbirth, or massive transfusion within 42 days of delivery. Sociodemographic factors included maternal age, residential area, income level, and region of hospital, delivery within the same area, delivery year, while obstetric factors included mode of delivery, status of multiple births, comorbidities, parity, and anesthetic methods. Data analysis was conducted using Generalized Estimating Equation model with a binomial distribution and logit link function to assess binary outcomes. The study also included subgroup analysis based on hospitals with or without MFICU. The results were reported as exponentiated values and presented as Exp(β) with 95% confidence intervals (CIs). Results: Women admitted to the intensive care unit (ICU) had a significantly lower likelihood of developing postpartum maternal complications compared to those who were not admitted (Exp(β): 0.77, 95% CI 0.52–0.94). Subgroup analyses by diagnosis revealed a significant reduction in the incidence of postpartum sepsis. Other complications, such as ICU admission, stillbirth, and maternal death, showed a decreasing trend, but the results were not statistically significant. Furthermore, there were no significant differences in the length of stay, total medical costs, or out-of-pocket expenses for women admitted to the ICU. When evaluating the health outcomes of neonates born to the high-risk mothers included in the analysis, premature birth and low birth weight increased (Exp(β): 1.16, 95% CI 1.09–1.24), although there was a tendency for a reduction in infant mortality. Conclusion: Utilization of MFICU in obstetric care has significantly reduced postpartum maternal morbidity in high-risk pregnant women. Key strategies include a multidisciplinary approach all of which are crucial for improving peripartum outcomes. These measures address current sociodemographic challenges and help ensure better care for high-risk mothers. Therefore, maintaining and enhancing obstetric care through effective MFICU utilization and continuous medical support policies is essential for improving maternal health outcomes