Clinical and sociodemographic determinants of miscarriage hospitalisation: Evidence from French healthcare records

Background: Despite miscarriages being common, little is known about who and to what extent people experiencing miscarriage resort to miscarriage care at the hospital. Methods: We analysed healthcare records from the French National Health Insurance Information System (SNDS) from 2015 to 2022. Descriptive analyses and logistic regressions estimated the trend in day (ambulatory) or longer (inpatient) miscarriage hospitalisation, and characteristics of those who received that type of care instead of primary care, emergency department visit, hospital external consultation, or no care.Results: On average, 44% of miscarriages identified in the healthcare records led to ambulatory or inpatient care, with a decrease from 44% to 41% before the COVID-19 lockdown, after which the trend increased again and stabilised. Those from precarious groups, undergoing infertility treatments, with underlying chronic conditions, prior history of miscarriages and births, between 35 and 45 years old, and those from rural areas, were more likely to be hospitalised. Conversely, those from urban areas and younger age groups were less likely to receive ambulatory or inpatient hospital care. Among these hospitalisations, financially precarious women, those with chronic conditions, and prior miscarriages, were also more likely to receive inpatient rather than ambulatory care. Conclusions: Ambulatory and inpatient miscarriage care decreased over time, which signifies a shift towards other types of care, or an increase in pregnancy losses managed outside the formal healthcare system. However, the decline levelled off after the onset of the COVID-19 pandemic. Those with underlying conditions and prior miscarriage(s) may more often experience complications and therefore seek (inpatient) hospital care, or have more monitored pregnancies, leading to planned interventions at the hospital. The greater likelihood of receiving (inpatient) hospital care among those living in rural areas may reflect challenges in accessing primary care due to limited availability of practitioners. Similarly, the greater (inpatient) hospitalisation rates among financially precarious women raise concerns about potential barriers to timely miscarriage care and more complications. Improving miscarriage care should involve addressing access barriers, counselling, and potential interventions for groups with specific needs when receiving formal healthcare for a miscarriage.