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Multicenter Study
. 2025 Jun 12;146(2):274-277.
doi: 10.1097/AOG.0000000000005971.

Validation of an Extended Maternal Comorbidity Index for Prediction of Severe Maternal Morbidity

Ann M Bruno  1 , Grecio J Sandoval, Brenna L Hughes, William A Grobman, George R Saade, Tracy A Manuck, Monica Longo, Hyagriv N Simhan, Dwight J Rouse, Hector Mendez-Figueroa, Cynthia Gyamfi-Bannerman, Jennifer L Bailit, Maged M Costantine, Harish M Sehdev, Alan T N Tita; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network*
Affiliations
Multicenter Study

Validation of an Extended Maternal Comorbidity Index for Prediction of Severe Maternal Morbidity

Ann M Bruno et al. Obstet Gynecol. .

Abstract

The expanded maternal comorbidity index developed by Leonard et al uses pre-existing maternal health conditions (eg, hypertension, asthma) to produce a risk score that predicts severe maternal morbidity (SMM). This tool has been adopted into clinical and research use without external validation in a data source not reliant on administrative codes. We assessed the validity of the maternal comorbidity index to predict SMM in a modern obstetric cohort using data derived from detailed medical record abstraction. In this secondary analysis of a multicenter cohort of patients delivering at 17 U.S. hospitals (2019-2020), the maternal comorbidity index risk score was applied to all individuals and the performance of the score to predict SMM was assessed using the area under the receiver operating curve (AUC). Of 20,898 individuals in this cohort, 668 (3.2%) experienced SMM. The AUC for the maternal comorbidity index was 0.72 (95% CI, 0.70-0.74) to predict SMM and 0.83 (95% CI, 0.79-0.86) to predict SMM without transfusion. The expanded maternal comorbidity index for prediction of SMM was externally valid, and findings support the ongoing use of this tool.

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Conflict of interest statement

Financial Disclosure Brenna L. Hughes reports receiving payment from UpToDate, Moderna, and Johns Hopkins. Cynthia Gyamfi-Bannerman reports her institution received funding grom Sera and Mirvie. Alan T. N. Tita reports his institution received funding from Pfizer and Mirvie. The other authors did not report any potential conflicts of interest.

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