Key result
Births at higher-level maternal care facilities were associated with lower odds of severe adverse outcomes among women with selected risk conditions like severe preeclampsia or PAS.
Why the study?
To determine associations between maternal risk conditions and severe adverse outcomes, and to assess whether these associations vary by level of maternal care.
Does delivery at higher-level maternal care facilities reduce severe adverse outcomes in pregnant women with high-risk conditions?
Observational
Yes
Does delivery at higher-level maternal care facilities reduce severe adverse outcomes in pregnant women with high-risk conditions?
Delivery at higher-level maternal care facilities is associated with lower odds of severe adverse outcomes for women with high-risk conditions such as severe preeclampsia or placenta accreta spectrum.
Supports higher-level facility delivery for high-risk pregnancies; leaves open causal confirmation in trials.
Objectives: To (1) determine associations between maternal risk conditions and severe adverse outcomes that may benefit from risk-appropriate care and (2) assess whether associations between risk conditions and outcomes vary by level of maternal care (LoMC). Methods: We used the 2017–2019 National Inpatient Sample (NIS) to calculate associations between maternal risk conditions and severe adverse outcomes. Risk conditions included severe preeclampsia, placenta accreta spectrum (PAS) conditions, and cardiac conditions. Outcomes included disseminated intravascular coagulation (DIC) with blood products transfusion or shock, pulmonary edema or acute respiratory distress syndrome (ARDS), stroke, acute renal failure, and a composite cardiac outcome. Then we used 2019 delivery hospitalization data from five states linked to hospital LoMC. We calculated associations between risk conditions and outcomes overall and stratified by LoMC and assessed for effect modification by LoMC. Results: We found positive measures of association between risk conditions and outcomes. Among patients with severe preeclampsia or PAS, the magnitudes of the associations with DIC with blood products transfusion or shock, pulmonary edema or ARDS, and acute renal failure were lower in Level III/IV compared with Conclusions: Odds of severe adverse outcomes among women with selected risk conditions were lower for births occurring at higher-level facilities, supporting the benefit of risk-appropriate care.
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DeSisto et al. (2024) conducted an observational in Maternal risk conditions (severe preeclampsia, placenta accreta spectrum, cardiac conditions). Higher level of maternal care (Level III/IV) vs. Lower level of maternal care was evaluated on Severe adverse outcomes including DIC with transfusion/shock, pulmonary edema/ARDS, stroke, acute renal failure, and composite cardiac outcome. Births at higher-level maternal care facilities were associated with lower odds of severe adverse outcomes among women with selected risk conditions like severe preeclampsia or PAS.
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