Increasing maternal morbidity: biggest factors aren't the usual suspects

  • Leonard SA & al.
  • BMC Pregnancy Childbirth
  • 9 Jan 2019

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • Pre-pregnancy comorbidity, advanced maternal age (AMA), and cesarean delivery (CD) contribute to severe maternal morbidity, but they do not completely account for the increasing trend of severe maternal morbidity in women delivering in California.

Why this matters

  • There has been recent media attention on increasing rates of maternal mortality and morbidity in the United States.
  • Understanding the cause of this trend may help shape public health policy.

Key results

  • Severe maternal morbidity occurred in 1.35% of deliveries.
  • Adjusted associations between identified risk factors and severe maternal morbidity (ORs; 95% CIs): 
    • AMA: 1.49 (1.45-1.52);
    • Pre-pregnancy obesity: 0.99 (0.97-1.01);
    • Pre-pregnancy comorbidity: 2.22 (2.16-2.28); and
    • CD: 2.66 (2.61-2.73).
  • The authors conclude that these findings do not support the hypothesis that changes in women's pre-pregnancy health and CD are the main contributors to increases in maternal morbidity.  

Study design

  • Retrospective cohort study.
  • Cohort identified from US birth certificate data from 2007 to 2014 (n=4,063,106).
  • Study outcome was severe maternal morbidity during delivery hospitalization.
  • Risk factors studied: AMA, pre-pregnancy obesity, pre-pregnancy comorbidity, and CD.
  • Funding: Eunice Kennedy Shriver NICHD; Stanford Maternal and Child Health Research Institute; National Institute of Nursing Research.

Limitations

  • Misclassification of data possible.