Severe Maternal Morbidity in Georgia, 2009-2020

Abstract

Background: The increasing focus of population surveillance and research on maternal-and not only fetal and infant-health outcomes is long overdue. The United States maternal mortality rate is higher than any other high-income country, and Georgia is among the highest rates in the country. Severe maternal morbidity (SMM) is conceived of as a "near miss" for maternal mortality, is 50 times more common than maternal death, and efforts to systematically monitor SMM rates in populations have increased in recent years. Much of the current population-based research on SMM has occurred in coastal states or large cities, despite substantial geographical variation with higher maternal and infant health burdens in the Southeast and rural regions.

Methods: This population-based study uses hospital discharge records linked to vital statistics to describe the epidemiology of SMM in Georgia between 2009 and 2020.

Results: Georgia had a higher SMM rate than the United States overall (189.2 vs. 144 per 10,000 deliveries in Georgia in 2014, the most recent year with US estimates). SMM was higher among racially minoritized pregnant persons and those at the extremes of age, of lower socioeconomic status, and with comorbid chronic conditions. SMM rates were 5 to 6 times greater for pregnant people delivering infants <1500 grams or <32 weeks' gestation as compared with those delivering normal weight or term infants. Since 2015, SMM has increased in Georgia.

Conclusion: SMM represents a collection of life-threatening emergencies that are unevenly distributed in the population and require increased attention. This descriptive analysis provides initial guidance for programmatic interventions intending to reduce the burden of SMM and, subsequently, maternal mortality in the US South.

FIGURE 1

Severe maternal mortality rates per 10,000 deliveries for non-Hispanic Black and non-Hispanic White women in Georgia, 2009–2020 stratified by selected demographic and clinical risk factors, using case definition including blood transfusion. A, Maternal age; B, Delivery insurance payor; C, clinical risk factors, including gestational diabetes, gestational hypertension, and pre-pregnancy hypertension. SMM indicates severe maternal morbidity

FIGURE 2

Annual SMM events per 10,000 deliveries among Georgia resident women ages 12–55 between 2009–2020, using case definition including and excluding blood transfusions. The break between the use of ICD-9-CM and ICD-10-CM codes reflects the change in CDC/AIM codes defining SMM events across ICD version. The dotted lines from 2019–2020 reflect the overlay of the COVID-19 pandemic. SMM indicates severe maternal morbidity.