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Poster Session 1

Category: Epidemiology

Poster Session 1

(256) Impact of 2016 ACOG Postpartum Care Guidelines on Postpartum Readmissions

Wednesday, February 11, 2026

10:30 AM - 12:00 PM

Submitting Author and Presenting Author(s)

Katherine Pressman, MD

Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
Tampa, Florida, United States

Coauthor(s)

JS

Jason L. Salemi, MPH, PhD

Professor
Department of Epidemiology, College of Public Health, University of South Florida, Tampa, Florida
Tampa, Florida, United States
JT

Jean Paul P. Tanner, MPH, PhD

Assistant Professor
Department of Epidemiology, College of Public Health, University of South Florida, Tampa, Florida
Tampa, Florida, United States
Daniela R. Crousillat, MD (she/her/hers)

Assistant Professor, Department of Medicine and Obstetrics and Gynecology
Division of Cardiovascular Sciences, Department of Medicine and Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
Tampa, Florida, United States
Mary A. Cain, MD

Associate Professor
Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida
Tampa, Florida, United States

Objective:
In 2016, ACOG published guidelines to optimize postpartum care, including earlier follow-up and surveillance for hypertensive disorders of pregnancy (HDP). We evaluated the association of these guidelines with changes in postpartum readmissions among HDP-affected deliveries.

Study Design:
We conducted an interrupted time series analysis using the 2011–2021 National Readmissions Database. Deliveries to individuals aged 12–55 were included; those in November or December were excluded to ensure complete 42-day follow-up. Deliveries were classified as pre-guideline (2011–2015) or post-guideline (2016–2021) and stratified by HDP status using ICD-9/10 codes. Postpartum readmissions were defined as any inpatient encounter within 42 days of delivery and categorized as all-cause or HDP-related based on diagnosis codes. Severe readmissions were defined using All Patient Refined Diagnosis Related Groups (APRDRG) severity metrics with severity of illness or risk of mortality scores of 3 (major) or 4 (extreme), based on 3M Health Information Systems Classifications.

Results:
Across the study period, there were 4.2 million HDP deliveries and 28.9 million non-HDP deliveries. Crude 42-day all-cause readmission rates were substantially higher among HDP deliveries compared to non-HDP (35.5 vs. 11.9 per 1,000 deliveries). Severe readmission rates among HDP and non-HDP groups were 9.5 and 2.8 per 1,000, respectively. Following the 2016 guidelines, all-cause readmissions among HDP deliveries increased significantly in trend relative to non-HDP (trend difference +0.095 per 1,000 deliveries per month, p< 0.001). HDP-specific readmissions increased in both level and trend (level difference +1.86 per 1,000, p=0.002; trend difference +0.11 per 1,000 per month, p< 0.001). Severe postpartum readmissions among HDP deliveries declined significantly, with a relative level decrease of 2.18 per 1,000 deliveries (p< 0.001) and a downward trend (p=0.019).

Conclusion:
The 2016 ACOG guidelines were associated with higher overall and HDP-specific readmissions but fewer severe readmissions.