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Epidemiology

Poster Session 3

(696) Trends in Antepartum Pyelonephritis Hospitalizations and Risk for Associated Sepsis and Severe Maternal Morbidity

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To characterize trends in antepartum pyelonephritis hospitalizations in the United States and related sepsis and non-transfusion severe maternal morbidity (ntSMM).

Study Design: The 2010-2020 Nationwide Readmissions Database was used for this retrospective cohort study. Delivery hospitalizations in October and November of each study year of patients aged 15-44 were identified. Linked antepartum admissions with a pyelonephritis diagnosis in the 9 months preceding delivery hospitalization were identified. Temporal trends in antepartum pyelonephritis admissions were analyzed using joinpoint regression to estimate the average annual percent change (AAPC) with 95% CIs. Risk for sepsis and ntSMM (excluding sepsis) among antepartum hospitalizations based on CDC criteria was similarly trended.

Results: Of 10,158,939 delivery hospitalizations, 49,147 (0.48%) had an antepartum admission with a pyelonephritis diagnosis in the 9 months preceding delivery. Of these antepartum admissions, 4470 (9.1%) had a sepsis diagnosis and 5093 (10.4%) had a severe morbidity diagnosis other than sepsis. The rate of antepartum pyelonephritis hospitalizations declined over the course of the study period from 56.4 per 10,000 in 2010 to 40.2 per 10,000 in 2020. This trend was significant (AAPC -2.9%, 95% CI -4.0%, -1.9%). However, the proportion of antepartum pyelonephritis hospitalizations with a sepsis diagnosis increased over the study period from 3.7% to 8.5% (AAPC 10.4%, 95% CI 8.3%, 13.4%). Risk for ntSMM also increased significantly over the study period from 5.0% to 20.0% (AAPC 13.8%, 95% CI 10.7, 17.9%).

Conclusion: Rate of antepartum pyelonephritis hospitalizations has declined over the decade, likely reflecting an increased adaptation of prenatal screening for urinary tract infections, treatment of asymptomatic bacteriuria, and use of antibacterial suppression. Although antepartum hospitalizations have declined, the proportions of hospitalizations for pyelonephritis with sepsis and severe morbidity have increased. Further investigation is indicated to reduce morbidity associated with antepartum pyelonephritis.