Severe prenatal, perinatal maternal morbidity underlies increased maternal mortality

  • JAMA Netw Open

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

  • Rising maternal mortality rates appear to be related to increased severe maternal morbidity during pregnancy and after delivery.

Why this matters

  • Rising maternal mortality rates have occurred in conjunction with the increasing prevalence of severe maternal morbidity.
  • Many cases of maternal death due to severe maternal morbidity may be preventable.

Key results

  • Maternal death rate was 9.3 per 100,000 births.
  • Severe maternal morbidity that arose during pregnancy or after delivery was far more likely in women who died (68.0% vs 1.7%).
  • The higher the number of severe maternal morbidity indicators, the higher the risk of maternal death:
    • 1 indicator, adjusted relative risk (aRR), 20.1 (95% CI, 11.6-34.7). 
    • 2 indicators, aRR, 101.6 (95% CI, 58.2-177.6).
    • ≥6 indicators, aRR, 2192.0 (95% CI, 1287.0-3735.0).

Study design

  • Population-based cohort study in Canada.
  • Cohort identified using hospital obstetric delivery records (n=1,953,943 births).
  • Main outcome was the number of severe maternal morbidity indicators identified during a pregnancy using ICD codes.
  • Funding: Canadian Institutes of Health Research and Institute for Clinical Evaluative Sciences.  

Limitations

  • The study did not include pregnancy ending prior to 20 weeks' gestation.

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