Risk Factors Associated with Maternal Postpartum Hospital Readmission: A Systematic Review

Background: Maternal postpartum hospital readmissions represent profound implications for maternal health outcomes and potential gaps in quality of maternal care. Objective: This study aims to synthesise evidence on risk factors for maternal postpartum hospital readmissions within 42 days of discharge following birth hospitalisation. Methods: An electronic database search utilised CINAHL, EMBASE (Ovid), and MEDLINE for relevant studies published from 1 January 2010 to 30 June 2024. The studies that investigated the prevalence and risk factors for 42-day postpartum maternal readmission and reported risk estimates, published in English, were included. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for case-control studies and cohort studies. The PRISMA guidelines were followed in reporting this review. The review protocol was registered on PROSPERO (CRD42023442269). Results: A total of 7758 articles were retrieved, ultimately including 60 studies. The rate of maternal postpartum readmissions varied from 0.1236‱ to 26%. Significant risk factors were extracted and categorised into five groups: maternal demographic and socio-economic factors; behavioural and lifestyle factors; health institution structural factors; obstetric and delivery characteristics; as well as maternal morbidity The most frequently cited risk factors which contributed to maternal postpartum hospital readmissions were age, race/ethnicity, substance use, caesarean delivery, length of maternal hospital stay, premature birth, and all maternal morbidities, especially mental health disorders, severe maternal morbidity, and hypertensive disorders of pregnancy. Conclusions: This systematic review identified complex and diverse risk factors associated with maternal postpartum hospital readmissions within 42 days after discharge following birth hospitalisation. This helps our understanding of the risk factors and the strength of association with maternal postpartum hospital readmissions. Future research should develop a multidimensional risk assessment framework to guide clinical practice in adopting holistic individualised approaches for postpartum risk evaluation, thereby reducing readmission rates and improving maternal health outcomes.