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Associations Between Comorbidities and Severe Maternal Morbidity.

Clare C Brown1, Caroline E Adams, Karen E George

  • 1Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Institute for Medicaid Innovation and the Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC; and the Department of Obstetrics & Gynecology, University of Michigan Medical School, Ann Arbor, Michigan.

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The number of chronic conditions significantly increases severe maternal morbidity risk. Addressing comorbidities in women of childbearing age could improve maternal health outcomes across all races and ethnicities.

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Area of Science:

  • Obstetrics and Gynecology
  • Public Health
  • Health Services Research

Background:

  • Severe maternal morbidity (SMM) poses a significant public health challenge.
  • Chronic conditions are increasingly prevalent among women of childbearing age.
  • Understanding the interplay between comorbidities, race, and SMM is crucial for targeted interventions.

Purpose of the Study:

  • To investigate the association between the number of chronic conditions and maternal race/ethnicity with the risk of severe maternal morbidity.
  • To quantify the increased risk of SMM associated with an increasing number of comorbidities.
  • To examine racial and ethnic disparities in comorbidity prevalence and their impact on SMM.

Main Methods:

  • Analysis of 1,480,925 delivery hospitalizations from the 2016-2017 National Inpatient Sample.
  • Utilized multivariable logistic regression to assess the risk of SMM based on comorbidity count and maternal race/ethnicity.
  • Controlled for potential confounding factors in the statistical models.

Main Results:

  • A clear dose-response relationship exists between the number of comorbidities and SMM risk.
  • Women with three or more comorbidities had a 9.1-fold increased risk of SMM (aOR 9.1, 95% CI 8.7-9.6) compared to those with no comorbidities.
  • Black women exhibited higher rates of comorbid conditions compared to White, Hispanic, and Asian women, though specific comorbidity prevalence data varied.

Conclusions:

  • The number of chronic conditions is a significant, independent risk factor for severe maternal morbidity.
  • Interventions focused on managing and preventing chronic conditions in women of childbearing age are essential for improving maternal outcomes.
  • Addressing disparities in chronic condition prevalence across racial and ethnic groups is vital for reducing SMM inequities.