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Population‐Based Study of Risk Factors for Severe Maternal Morbidity
Author(s) -
Gray Kristen E.,
Wallace Erin R.,
Nelson Kailey R.,
Reed Susan D.,
Schiff Melissa A.
Publication year - 2012
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1111/ppe.12011
Subject(s) - medicine , birth certificate , odds ratio , obstetrics , confidence interval , population , parity (physics) , pacific islanders , pregnancy , logistic regression , body mass index , eclampsia , caesarean delivery , demography , caesarean section , environmental health , physics , particle physics , sociology , biology , genetics
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 20 000 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.