Risk of recurrent severe maternal morbidity: a population-based study

Ugochinyere Vivian Ukah; Robert W Platt; Nathalie Auger; Sarka Lisonkova; Joel G Ray; Isabelle Malhamé; Aimina Ayoub; Darine El-Chaâr; Natalie Dayan

doi:10.1016/j.ajog.2023.06.010

Risk of recurrent severe maternal morbidity: a population-based study

Am J Obstet Gynecol. 2023 Nov;229(5):545.e1-545.e11. doi: 10.1016/j.ajog.2023.06.010. Epub 2023 Jun 8.

Authors

Ugochinyere Vivian Ukah¹, Robert W Platt², Nathalie Auger³, Sarka Lisonkova⁴, Joel G Ray⁵, Isabelle Malhamé⁶, Aimina Ayoub³, Darine El-Chaâr⁷, Natalie Dayan⁸

Affiliations

¹ Institut national de santé publique du Québec, Montreal, Canada; HealthPartners Institute, Pregnancy and Child Health Research Center, Bloomington, MN; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
² Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
³ Institut national de santé publique du Québec, Montreal, Canada.
⁴ Department of Obstetrics and Gynaecology and the BC Children's and Women's Hospital, The University of British Columbia, Vancouver, Canada.
⁵ Department of Medicine and the Institute of Health Policy and Evaluation, University of Toronto, Toronto, Canada.
⁶ Department of Medicine, McGill University Health Centre, Montreal, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
⁷ Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.
⁸ Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Department of Medicine, McGill University Health Centre, Montreal, Canada; Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada. Electronic address: natalie.dayan@mcgill.ca.

PMID: 37301530
DOI: 10.1016/j.ajog.2023.06.010

Abstract

Background: Severe maternal morbidity is a composite indicator of maternal health and obstetrical care. Little is known about the risk of recurrent severe maternal morbidity in a subsequent delivery.

Objective: This study aimed to estimate the risk of recurrent severe maternal morbidity in the next delivery after a complicated first delivery.

Study design: We analyzed a population-based cohort study of women with at least 2 singleton hospital deliveries between 1989 and 2021 in Quebec, Canada. The exposure was severe maternal morbidity in the first hospital-recorded delivery. The study outcome was severe maternal morbidity at the second delivery. Log-binomial regression models adjusted for maternal and pregnancy characteristics were used to generate relative risks and 95% confidence intervals comparing women with and without severe maternal morbidity at first delivery.

Results: Among 819,375 women, 43,501 (3.2%) experienced severe maternal morbidity in the first delivery. The rate of severe maternal morbidity recurrence at second delivery was 65.2 vs 20.3 per 1000 in women with and without previous severe maternal morbidity (adjusted relative risk, 3.11; 95% confidence interval, 2.96-3.27). The adjusted relative risk for recurrence of severe maternal morbidity was greatest among women who had ≥3 different types of severe maternal morbidity at their first delivery, relative to those with none (adjusted relative risk, 5.50; 95% confidence interval, 4.26-7.10). Women with cardiac complication at first delivery had the highest risk of severe maternal morbidity in the next delivery.

Conclusion: Women who experience severe maternal morbidity have a relatively high risk of recurrent morbidity in the subsequent pregnancy. In women with severe maternal morbidity, these study findings have implications for prepregnancy counseling and maternity care in the next pregnancy.

Keywords: cardiac complications; maternal complications; near-miss; preeclampsia; pregnancy complications; severe maternal morbidity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Cohort Studies
Female
Humans
Maternal Health Services*
Obstetrics*
Pregnancy
Risk