Association between stillbirth and severe maternal morbidity - 06/03/24
Abstract |
Background |
Severe maternal morbidity has been increasing in the past few decades. Few studies have examined the risk of severe maternal morbidity among individuals with stillbirths vs individuals with live-birth deliveries.
Objective |
This study aimed to examine the prevalence and risk of severe maternal morbidity among individuals with stillbirths vs individuals with live-birth deliveries during delivery hospitalization as a primary outcome and during the postpartum period as a secondary outcome.
Study Design |
This was a retrospective cohort study using birth and fetal death certificate data linked to hospital discharge records from California (2008–2018), Michigan (2008–2020), Missouri (2008–2014), Pennsylvania (2008–2014), and South Carolina (2008–2020). Relative risk regression analysis was used to examine the crude and adjusted relative risks of severe maternal morbidity along with 95% confidence intervals among individuals with stillbirths vs individuals with live-birth deliveries, adjusting for birth year, state of residence, maternal sociodemographic characteristics, and the obstetric comorbidity index.
Results |
Of the 8,694,912 deliveries, 35,012 (0.40%) were stillbirths. Compared with individuals with live-birth deliveries, those with stillbirths were more likely to be non-Hispanic Black (10.8% vs 20.5%); have Medicaid (46.5% vs 52.0%); have pregnancy complications, including preexisting diabetes mellitus (1.1% vs 4.3%), preexisting hypertension (2.3% vs 6.2%), and preeclampsia (4.4% vs 8.4%); have multiple pregnancies (1.6% vs 6.2%); and reside in South Carolina (7.4% vs 11.6%). During delivery hospitalization, the prevalence rates of severe maternal morbidity were 791 cases per 10,000 deliveries for stillbirths and 154 cases per 10,000 deliveries for live-birth deliveries, whereas the prevalence rates for nontransfusion severe maternal morbidity were 502 cases per 10,000 deliveries for stillbirths and 68 cases per 10,000 deliveries for live-birth deliveries. The crude relative risk for severe maternal morbidity was 5.1 (95% confidence interval, 4.9–5.3), whereas the adjusted relative risk was 1.6 (95% confidence interval, 1.5–1.8). For nontransfusion severe maternal morbidity among stillbirths vs live-birth deliveries, the crude relative risk was 7.4 (95% confidence interval, 7.0–7.7), whereas the adjusted relative risk was 2.0 (95% confidence interval, 1.8–2.3). This risk was not only elevated among individuals with stillbirth during the delivery hospitalization but also through 1 year after delivery (severe maternal morbidity adjusted relative risk, 1.3; 95% confidence interval, 1.1–1.4; nontransfusion severe maternal morbidity adjusted relative risk, 1.2; 95% confidence interval, 1.1–1.3).
Conclusion |
Stillbirth was found to be an important contributor to severe maternal morbidity.
Le texte complet de cet article est disponible en PDF.Key words : acute renal failure, disseminated intravascular coagulation, obstetric comorbidity index score, postpartum, sepsis, severe maternal morbidity, shock, stillbirth, transfusion
Plan
| The authors report no conflict of interest. |
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| This study is supported by the National Institute on Minority Health and Health Disparities under award number R01MD016012. |
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| The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health (NIH). The NIH had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government. |
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| The data used in this document and presentation were acquired from the Michigan Department of Health and Human Services (MDHHS) and the Missouri Department of Health and Senior Services (DHSS). The contents of this document, including data analysis, interpretation, or conclusions, are solely the responsibility of the authors and do not represent the official views of the MDHHS or DHSS. |
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| Our information was taken from the records of the Revenue and Fiscal Affairs Office, Health and Demographics Section, South Carolina. Our authorization to release this information does not imply endorsement of this study or its findings by either the revenue and fiscal affairs office or the data oversight council. |
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| Cite this article as: Nyarko SH, Greenberg LT, Phibbs CS, et al. Association between stillbirth and severe maternal morbidity. Am J Obstet Gynecol 2024;230:364.e1-14. |
Vol 230 - N° 3
P. 364.e1-364.e14 - mars 2024 Retour au numéro
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