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. 2020 Nov;136(5):892-901.
doi: 10.1097/AOG.0000000000004057.

Associations Between Comorbidities and Severe Maternal Morbidity

Clare C Brown  1 , Caroline E Adams, Karen E George, Jennifer E Moore
Affiliations

Associations Between Comorbidities and Severe Maternal Morbidity

Clare C Brown et al. Obstet Gynecol. 2020 Nov.

Abstract

Objective: To evaluate the associations between the number of chronic conditions and maternal race and ethnicity (race) with the risk of severe maternal morbidity.

Methods: Using the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, years 2016-2017, we examined risk of severe maternal morbidity among 1,480,925 delivery hospitalizations among women of different races and with different numbers of comorbid conditions using multivariable logistic regression.

Results: The rate of severe maternal morbidity was 139.7 per 10,000 deliveries. Compared with women with no comorbidities (rate 48.5/10,000), there was increased risk of severe maternal morbidity among women with one comorbidity (rate 238.6; odds ratio [OR] 5.0, 95% CI 4.8-5.2), two comorbidities (rate 379.9; OR 8.1, 95% CI 7.8-8.5), or three or more comorbidities (rate 560; OR 12.1, 95% CI 11.5-12.7). In multivariable regressions, similar associations were noted for women with one (adjusted odds ratio [aOR] 4.4, 95% CI 4.2-4.6), two (aOR 6.6, 95% CI 6.3-6.9), or three or more comorbidities (aOR 9.1, 95% CI 8.7-9.6). Black women had higher rates of comorbid conditions than all other racial and ethnic groups, with 55% (95% CI 54-56%) of Black women having no comorbidities, compared with 67% (95% CI 67-68%) of White women, 68% (95% CI 67-69%) of Hispanic women, and 72% (95% CI 71-73%) of Asian women.

Conclusion: We found a dose-response relationship between number of comorbidities and risk of severe maternal morbidity, with the highest rates of severe maternal morbidity among women with three or more comorbidities. Focusing on the prevention and treatment of chronic conditions among women of childbearing age may have the potential to improve maternal outcomes across races and ethnicities.

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Conflict of interest statement

Financial Disclosure

The authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal’s requirements for authorship.

Figures

Figure 1:
Figure 1:
Rate of severe maternal morbidity per 10,000 deliveries, by race (unweighted n=1,480,925), identified using the Centers for Disease Control and Prevention severe maternal morbidity indicator list. Number of comorbidities calculated among 25 Elixhauser comorbidity measures. See Appendix 3 (http://links.lww.com/AOG/C28) for full comorbidity description. Horizontal bars indicate 95% CIs, which were constructed without using the weighted N in order to avoid artificially narrow confidence intervals.
Figure 2:
Figure 2:
Rate of severe maternal morbidity excluding deliveries with only blood transfusion per 10,000 deliveries, by race and number of comorbid conditions (unweighted n=1,480,925; weighted n=7,404,617). The rate of Severe Maternal Morbidity excluding blood transfusions, per 10,000 deliveries, identified using the Centers for Disease Control and Prevention algorithm. Horizontal bars indicate 95% confidence intervals (CIs), which were constructed without using the weighted n to avoid artificially narrow CIs.
Figure 3:
Figure 3:
Percentage of individuals within each comorbid condition category, by race (unweighted n=1,480,925). Number of comorbidities calculated among 25 Elixhauser comorbidity measures. See Appendix 3 (http://links.lww.com/AOG/C28) for full comorbidity description. Horizontal bars indicate 95% CIs, which were constructed without using the weighted N in order to avoid artificially narrow confidence intervals.
See this image and copyright information in PMC

References

    1. Kilpatrick SK, Ecker JL, American College of Obstetricians and Gynecologists. Severe maternal morbidity: screening and review. Obstet Gynecol. 2016;215(3):B17–B22. - PubMed
    1. Liese KL, Mogos M, Abboud S, Decocker K, Koch AR, Geller SE. Racial and ethnic disparities in severe maternal morbidity in the United States. Journal of racial and ethnic health disparities. 2019;6(4):790–798. - PubMed
    1. Centers for Disease Control and Prevention. Pregnancy-related mortality surveillance. 2020. Accessed at https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mort....
    1. Fingar KF (IBM Watson Health), Hambrick MM (AHRQ), Heslin KC (AHRQ), Moore JE (Institute for Medicaid Innovation). Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Morbidity, 2006-2015. HCUP Statistical Brief #243. September 2018. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/statbriefs/sb243-Severe-Maternal-Morbidity-.... - PubMed
    1. Admon LK, Winkelman TN, Zivin K, Terplan M, Mhyre JM, Dalton VK. Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012-2015. Obstetrics & Gynecology. 2018;132(5):1158–1166. - PubMed

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