Associations Between State-Level Severe Maternal Morbidity and Other Perinatal Indicators

Abstract

This cross-sectional study examines state-level associations between severe maternal morbidity and other perinatal indicators, including prepregnancy hypertension, prepregnancy diabetes, prepregnancy obesity, low-risk cesarean delivery, preterm birth, and maternal and infant mortality.

State Variation in Severe Maternal Morbidity Among Individuals with Medicaid Insurance

“…Our studies of HCUP-SID data published in JAMA Network Open 5,6 also found large state-level variation in SMM at delivery but with little geographic patterning, and state rates were not associated with most other perinatal indicators, including maternal mortality. Several states experienced rapid increases in SMM, and the correlation between state-level SMM rates in 2012 and 2019 was only 0.47.…”

“…Examination of Transformed Medicaid Statistical Information System Analytic Files complements existing population-based, all-payer data from the Healthcare Cost and Utilization Project State Inpatient Databases (HCUP-SID) accessible through HCUP Fast Stats 3 (by state of hospitalization) and the Title V Information System 4 (by state of residence), which use updated SMM codes to better bridge the International Classification of Diseases, Tenth Revision, Clinical Modification-Procedure Coding System transition. 5 Our studies of HCUP-SID data published in JAMA Network Open 5,6 also found large state-level variation in SMM at delivery but with little geographic patterning, and state rates were not associated with most other perinatal indicators, including maternal mortality. Several states experienced rapid increases in SMM, and the correlation between state-level SMM rates in 2012 and 2019 was only 0.47.…”

Obstetric Volume and Severe Maternal Morbidity Among Low-Risk and Higher-Risk Patients Giving Birth at Rural and Urban US Hospitals

“…We used International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes to identify if any of the 20 indicators of SMM occurred during the delivery hospitalization. As is now recommended by the US Health Resources and Services Administration and others, we did not include blood products transfusion as an indicator of SMM . The SMM indicators represent either serious complications of pregnancy or delivery, such as sepsis or acute kidney failure, or procedures used to manage serious conditions, such as mechanical ventilation or hysterectomy.…”

“…There is a positive volume-outcome association for many surgical conditions, such as trauma care and complex surgical procedures, and for neonatal intensive care units, but there are less available data for obstetric services. Some evidence indicates that the volume of births is associated with maternal outcomes, with lower-volume facilities having higher risks of mortality and serious morbidity, although this evidence is not consistent for all maternal outcomes or across all types of rural/urban geographic locations.…”

“…Whether hospital obstetric volume may be associated with poor maternal health could have important policy implications. Given that the existing literature suggests some potential benefits of increased obstetric volume, there could be benefits from strategic consolidation of obstetric services in select settings . However, there are trade-offs between service consolidation and access.…”