Maternal risk factors including age ≥40 years (OR 2.48; 95% CI 2.16-2.81) and multiple birth (OR 2.54; 95% CI 2.26-2.82) were significantly associated with increased severe maternal morbidity.
Case-Control (n=50,597)
What are the risk factors for severe maternal morbidity in a population-based cohort?
Non-modifiable risk factors such as advanced maternal age, non-White race, pre-existing medical conditions, and prior caesarean delivery significantly increase the risk of severe maternal morbidity, highlighting the need for provider and system-level preventive strategies.
Odds Ratio: 2.54 (95% CI 2.26–2.82)
BACKGROUND: Severe maternal morbidity (SMM) is a serious health condition potentially resulting in death without immediate medical attention, including organ failure, obstetric shock and eclampsia. SMM affects 20000 US women every year; however, few population-based studies have examined SMM risk factors. METHODS: We conducted a population-based case-control study linking birth certificate and hospital discharge data from Washington State (1987-2008), identifying 9485 women with an antepartum, intrapartum or postpartum SMM with ≥3-day hospitalisation or transfer from another facility and 41 112 random controls. Maternal age, race, smoking during pregnancy, parity, pre-existing medical condition, multiple birth, prior caesarean delivery, and body mass index were assessed as risk factors with logistic regression to estimate odds ratios (OR) and 95% confidence intervals CI, adjusted for education and delivery payer source. RESULTS: Older women (35-39: OR 1.65 CI 1.52, 1.79; 40+: OR 2.48 CI 2.16, 2.81), non-White women (Black: OR 1.82 CI 1.64, 2.01; American Indian: OR 1.52 CI 1.32, 1.73; Asian/Pacific Islander: OR 1.30 CI 1.19, 1.41; Hispanic: OR 1.17 CI 1.07, 1.27) and women at parity extremes (nulliparous: OR 1.83 CI 1.72, 1.95; parity 3+: OR 1.34 CI 1.23, 1.45) were at greater risk of SMM. Women with a pre-existing medical condition (OR 2.10 CI 1.88, 2.33), a multiple birth (OR 2.54 CI 2.26, 2.82) and a prior caesarean delivery (OR 2.08 CI 1.93, 2.23) were also at increased risk. CONCLUSION: The risk factors identified are not modifiable at the individual level; therefore, provider and system-level factors may be the most appropriate target for preventing SMM.
Gray et al. (Mon,) conducted a case-control in Severe maternal morbidity (n=50,597). Maternal risk factors (e.g., older age, multiple birth, prior caesarean) vs. Absence of respective risk factors was evaluated on Severe maternal morbidity (OR 2.54, 95% CI 2.26-2.82). Maternal risk factors including age ≥40 years (OR 2.48; 95% CI 2.16-2.81) and multiple birth (OR 2.54; 95% CI 2.26-2.82) were significantly associated with increased severe maternal morbidity.
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