Severe maternal morbidity from pregnancy through 1 year postpartum

Nansi S Boghossian; Lucy T Greenberg; Jeffrey S Buzas; Jeannette Rogowski; Scott A Lorch; Molly Passarella; George R Saade; Ciaran S Phibbs

doi:10.1016/j.ajogmf.2024.101385

Severe maternal morbidity from pregnancy through 1 year postpartum

Am J Obstet Gynecol MFM. 2024 May 18;6(7):101385. doi: 10.1016/j.ajogmf.2024.101385. Online ahead of print.

Authors

Nansi S Boghossian¹, Lucy T Greenberg², Jeffrey S Buzas³, Jeannette Rogowski⁴, Scott A Lorch⁵, Molly Passarella⁶, George R Saade⁷, Ciaran S Phibbs⁸

Affiliations

¹ Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC (Boghossian). Electronic address: nboghoss@email.sc.edu.
² Vermont Oxford Network, Burlington, VT (Greenberg).
³ Department of Mathematics and Statistics, University of Vermont, Burlington, VT (Buzas).
⁴ Department of Health Policy and Administration, The Pennsylvania State University, State College, PA (Rogowski).
⁵ Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA (Lorch and Passarella); Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia, PA (Lorch).
⁶ Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA (Lorch and Passarella).
⁷ Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Saade).
⁸ Departments of Pediatrics and Health Policy, Stanford University School of Medicine, Stanford, CA (Phibbs); Health Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA (Phibbs).

PMID: 38768903
DOI: 10.1016/j.ajogmf.2024.101385

Abstract

Background: Few recent studies have examined the rate of severe maternal morbidity occurring during the antenatal and/or postpartum period to 42 days after delivery. However, little is known about the rate of severe maternal morbidity occurring beyond 42 days after delivery.

Objective: This study aimed to examine the distribution of severe maternal morbidity and its indicators during antenatal, delivery, and postpartum hospitalizations to 365 days after delivery and to estimate the increase in severe maternal morbidity rate and its indicators after accounting for antenatal and postpartum severe maternal morbidity to 365 days after delivery.

Study design: This was a retrospective cohort study using birth and fetal death certificate data linked to hospital discharge records from Michigan, Oregon, and South Carolina from 2008 to 2020. This study examined the distribution of severe maternal morbidity, nontransfusion severe maternal morbidity, and severe maternal morbidity indicators during antenatal, delivery, and postpartum hospitalizations to 365 days after delivery. Subsequently, this study examined "severe maternal morbidity cases added," which represent cases among unique individuals that are included by considering the antenatal and postpartum periods but that would be missed if only the delivery hospitalization cases were included.

Results: A total of 64,661 (2.5%) individuals experienced severe maternal morbidity, whereas 37,112 (1.4%) individuals experienced nontransfusion severe maternal morbidity during antenatal, delivery, and/or postpartum hospitalization. A total of 31% of severe maternal morbidity cases were added after accounting for severe maternal morbidity occurring during the antenatal or postpartum hospitalization to 365 days after delivery, whereas 49% of nontransfusion severe maternal morbidity cases were added after accounting for nontransfusion severe maternal morbidity occurring during the antenatal or postpartum periods. Severe maternal morbidity occurring between 43 and 365 days after delivery contributed to 12% of all severe maternal morbidity cases, whereas nontransfusion severe maternal morbidity occurring between 43 and 365 days after delivery contributed to 19% of all nontransfusion severe maternal morbidity cases.

Conclusion: Our study showed that a total of 31% of severe maternal morbidity and 49% of nontransfusion severe maternal morbidity cases were added after accounting for severe maternal morbidity occurring during the antenatal or postpartum hospitalization to 365 days after delivery. Our findings highlight the importance of expanding the severe maternal morbidity definition beyond the delivery hospitalization to better capture the full period of increased risk, identify contributing factors, and design strategies to mitigate this risk. Only then can we improve outcomes for mothers and subsequently the quality of life of their infants.

Keywords: antenatal; postpartum; severe maternal morbidity.

Grants and funding

R01 MD016012/MD/NIMHD NIH HHS/United States