Maternal and Child Health Journal

, Volume 18, Issue 3, pp 640–647 | Cite as

Predictors and Adverse Pregnancy Outcomes Associated with Antepartum Discharge Against Medical Advice

  • Brownsyne Tucker Edmonds
  • Corinne Ahlberg
  • Katie McPherson
  • Sindhu Srinivas
  • Scott Lorch


To determine predictors and pregnancy outcomes associated with antepartum discharge against medical advice (AMA D/C). Retrospective cohort study of state-level maternal and infant hospital discharge data linked to vital statistics data for antepartum admissions in California from 1995 to 2005. (N = 203,250). After adjusting for comorbid conditions, the odds of AMA D/C for Black women were twice that of white women (OR = 2.00, 95 % CI 1.70–2.35). Publicly insured women had 3.5 times the odds of AMA D/C compared to privately insured women (OR = 3.54, 95 % CI 3.02–4.15). AMA D/C was also higher among substance abusers and women with mental illness (OR = 1.96, 95 % CI 1.43–2.67 and OR = 4.45, 95 % CI 3.81–5.21 respectively). Most notably, AMA D/C tripled the odds of fetal death in patients admitted for pregnancy-induced hypertension (OR = 3.08, 95 % CI 1.36–6.98) and increased the odds of neonatal morbidity (respiratory distress syndrome OR = 1.35, 95 % CI 1.07–1.70 and small-for-gestational-age OR = 1.47, 95 % CI 1.15–1.89) in patients admitted with preterm premature rupture of membranes. Vulnerable populations and patients with comorbid medical and mental illnesses are at increased risk for AMA D/C and its associated adverse pregnancy outcomes. Targeted interventions and resources to support at-risk populations are needed.


Antepartum admission  Discharge against medical advice  Pregnancy outcomes 


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Brownsyne Tucker Edmonds
    • 1
  • Corinne Ahlberg
    • 2
  • Katie McPherson
    • 3
  • Sindhu Srinivas
    • 4
  • Scott Lorch
    • 5
  1. 1.Department of Obstetrics and GynecologyIndiana University School of MedicineIndianapolisUSA
  2. 2.Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  3. 3.Indiana University School of MedicineIndianapolisUSA
  4. 4.Department of Obstetrics and Gynecology, Center for Research on Reproduction and Women’s HealthUniversity of Pennsylvania, Maternal and Child Health Research Program, Leonard Davis InstitutePhiladelphiaUSA
  5. 5.Department of Pediatrics, Division of Neonatology, Center for Outcomes ResearchUniversity of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Leonard Davis InstitutePhiladelphiaUSA

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