Long‐Term Maternal Health Outcomes Following Severe Maternal Morbidity: A Cohort Study

OBJECTIVE: To investigate the long-term morbidity experienced by women with a history of severe maternal morbidity (SMM). DESIGN: Prospective population-based cohort study. SETTING: A tertiary medical centre. POPULATION: All women who experienced SMM between 2013 and 2018 and a matched comparison group without SMM. METHODS: SMM was defined as maternal admission to the intensive care unit during the delivery hospitalisation. Women with SMM were matched 1:1 to controls based on mode and year of delivery. Multivariable Cox proportional hazards regression models were used to assess the adjusted risks of long-term diagnoses and hospitalisations, controlling for sociodemographic and clinical characteristics. MAIN OUTCOME MEASURES: Long-term incidence of morbidities and hospitalisations. RESULTS: A total of 288 women were included in the study, with a follow-up ranging from 6 to 11 years following the index pregnancy. Compared to women with no SMM in the index pregnancy, the SMM group demonstrated a significantly higher risk of cardiovascular and endocrine morbidities (adjusted HR: 4.01, 95% CI: 2.03-7.90 and 2.17; 95% CI: 1.24-3.79, respectively). Additionally, women with SMM in the index pregnancy had higher rates of SMM-related hospitalisations (adjusted HR: 1.90, 95% CI: 1.10-3.29), all-cause hospitalisations (adjusted HR: 2.21, 95% CI: 1.36-3.58) and hospitalisations within the first year following the index pregnancy (adjusted HR: 4.94, 95% CI: 1.06-23.13). CONCLUSIONS: Women with SMM require vigilant multidisciplinary medical surveillance following discharge from their delivery hospitalisation. The occurrence of SMM may serve as a warning sign of significant long-term health risks.