Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Abstract

Background Severe maternal morbidity (SMM) prevalence was 194.0 per 10 000 deliveries in Texas in 2015. Chronic, behavioral, and pregnancy‐induced conditions, as captured by a maternal comorbidity index, increase the risk for delivery‐related morbidity and mortality. The objective of the study was to examine the association between maternal comorbidity index and SMM among delivery hospitalizations in Texas. Methods Delivery‐related hospitalizations among Texan women aged 15‐49 years were identified using the 2011‐2014 Texas all‐payer inpatient hospitalization public use data files (n = 1 434 441). The primary outcome of interest was SMM, based on the Alliance for Innovation on Maternal Health's coding scheme. The exposure of interest was a maternal comorbidity index. Multivariable logistic regression model was used to examine the association between maternal comorbidity index and SMM. Results SMM prevalence remained consistent between 2011 and 2014 (196.0‐197.0 per 10 000 deliveries, P > .05; n = 1 434 441). Nearly 40% of delivery‐related hospitalizations had a maternal comorbidity index of at least 1, and the proportion of deliveries in the highest risk category of comorbidity index (≥5) increased by 12.0% from 2011 to 2014. SMM prevalence was highest among the youngest and oldest age groups. With each unit increase in maternal comorbidity index, the odds of SMM increase was 1.43 (95% CI 1.42‐1.43). Conclusions Maternal comorbidity index is associated with SMM; however, the low predictive power of the model suggests that other, unmeasured factors may influence SMM in Texas. These findings highlight a need to understand broader contextual factors (practitioner, facility, systems of care, and community) that may be associated with SMM to reduce maternal morbidity and mortality in Texas.

Identification of racial/ethnic disparities associated with severe maternal morbidity using the Arkansas All‐Payer Claims Database (2013‐2017)

“…Adjusting for clinical comorbidities in our study reduced the relative Black–white disparity in SMM; however, substantial Black–white disparities in SMM remain in fully adjusted models. This finding aligns with previous studies that have found that clinical comorbidities alone may not be sufficient in predicting adverse maternal outcomes 21 . This suggests that continued efforts to better measure and evaluate other social determinants of health, and to eradicate harmful aspects of US maternity care such as structural racism, inequitable access to the health care systems, and implicit biases during clinical encounters are critical for ensuring health equity across racial/ethnic groups.…”

“…This finding aligns with previous studies that have found that clinical comorbidities alone may not be sufficient in predicting adverse maternal outcomes. 21 This suggests that continued efforts to better measure and evaluate other social determinants of health, and to eradicate harmful aspects of US maternity care such as structural racism, inequitable access to the health care systems, and implicit biases during clinical encounters are critical for ensuring health equity across racial/ethnic groups. In our study, claims data were linked to the birth certificate to make use of other important measures such as socioeconomic factors (e.g., marital status, education and WIC participation) and previous gynecological and obstetrical history (e.g., parity).…”

Risk Factors for Severe Maternal Morbidity Among Women Enrolled in Mississippi Medicaid

“…In the literature, a number of risk factors for SMM and mortality have been identified, including maternal age, cesarean delivery, multifetal gestation, obesity, and preexisting chronic conditions . There is also evidence that additional factors, including obstetric and medical factors, unmarried status, low maternal education, and rural residency, may potentially increase the risk of SMM and pregnancy-related mortality . Although these clinical and sociodemographic factors are critical in understanding the maternal health crisis, it is equally important to investigate factors associated with availability, quality, and accessibility of maternity care resources .…”

“… 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 There is also evidence that additional factors, including obstetric and medical factors, unmarried status, low maternal education, and rural residency, may potentially increase the risk of SMM and pregnancy-related mortality. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 Although these clinical and sociodemographic factors are critical in understanding the maternal health crisis, it is equally important to investigate factors associated with availability, quality, and accessibility of maternity care resources. 26 These health care access factors will help to address spatial disparities and resource allocation in maternal care access in a particular region.…”

Severe Maternal Morbidity in Georgia, 2009–2020

“…However, there is a relative paucity of evidence specifically describing the scope, extent, and patterns of SMM in the US South. With only a few exceptions [20][21][22] there is sparse evidence describing the epidemiologic patterns and population burden of SMM in the very states where both overall burden and racial and ethnic disparities are historically largest. For example, the pregnancy-related mortality ratio in Georgia from 2015 to 2017 was 25.1 per 100,000 live births, 23 among the highest rates in the United States.…”