53 - Maternal Employment Following Prolonged Neonatal Hospitalization

Publication Number: 4052.53

K. Griffin Gorsky, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Brianna Keefe-Oates, Northeastern University, Portland, ME, United States; Louisa H.. Smith, Northeastern University, Portland, ME, United States

Background: A prolonged hospitalization of an infant after birth places substantial financial strain on parents. Families with lower incomes appear to be most impacted. Little is known about how a prolonged neonatal hospitalization impacts maternal employment in the first year of life across different demographic groups.

Objective: We aimed to assess the association between return to work, prolonged neonatal hospitalization, and key sociodemographic factors among mothers who worked during pregnancy.

Design/Methods: Data were obtained from 13 states and one city participating in the CDC's annual Pregnancy Risk Assessment and Monitoring System from 2016-2022. We included respondents >18 years old with live births who worked during pregnancy. Prolonged neonatal hospitalization was defined as infant hospitalization >14 days. We fit separate logistic regression models to estimate odds ratios between return-to-work plans and postnatal hospitalization and its interaction with select sociodemographic characteristics. We report marginal probabilities of returning to work conditional on prolonged hospitalization and each selected characteristic. All analyses adjusted for maternal age, income, state of residence, number of dependents, pregnancy hypertension and diabetes, and the other sociodemographic characteristics. Analysis accounted for the PRAMS survey design.

Results: Out of 47,409 eligible participants, 3.4% (n = 3,651) of mothers reported a prolonged neonatal hospitalization. After adjustment, mothers with prolonged hospitalization were significantly less likely to return to work compared to those without (75.1% vs. 79.2%) (Figure 1). This difference was largely consistent when stratified across sociodemographic categories. The largest gaps in the probability of returning to work associated with neonatal hospitalization were among people living in rural areas (72.3 vs. 79.6), on WIC (72.6 vs. 78.6), and of Hispanic ethnicity (74.0 vs. 79.6). Smaller differences were seen among people who were married (76.3 vs. 79.0) and among some racial groups, though confidence intervals were wide.

Conclusion(s): Among mothers working during pregnancy, prolonged neonatal hospitalization was associated with a decreased probability of returning to work, which may reflect the added demands of caring for a medically complex infant. Mothers with a prolonged neonatal hospitalization who also reported utilizing programs such as WIC and Medicaid had the lowest probabilities of returning to work. These findings may have implications for policy given recent legislative efforts to incorporate employment status into eligibility for social programs.

Figure 1. Marginal probabilities of return to work across demographic categories stratified by neonatal hospital duration