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Using Longitudinally Linked Data to Measure Severe Maternal Morbidity.

Eugene R Declercq1, Howard J Cabral, Xiaohui Cui

  • 1Boston University School of Public Health, Boston, the Massachusetts Department of Public Health, Boston, Evalogic Services, Inc, Newton, the Tufts University School of Medicine, Boston, and the Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, San Diego, California.

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Summary

Applying a standard algorithm to prenatal and postpartum hospitalizations significantly increases the identification of severe maternal morbidity (SMM). This comprehensive approach, including hospitalizations beyond delivery, is crucial for accurate SMM surveillance.

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Area of Science:

  • Maternal Health
  • Public Health Surveillance
  • Healthcare Quality Improvement

Background:

  • Severe maternal morbidity (SMM) poses a significant public health challenge.
  • Current SMM identification often focuses primarily on delivery events.
  • Comprehensive surveillance is needed to capture the full scope of maternal morbidity.

Purpose of the Study:

  • To evaluate if a standard algorithm applied to prenatal and postpartum hospitalizations enhances SMM identification beyond delivery-only analysis.
  • To assess the impact of including antenatal and early postpartum periods on SMM case ascertainment.

Main Methods:

  • Retrospective cohort study using the PELL database (2009-2018).
  • Application of a modified CDC algorithm for SMM to hospitalizations from antenatal through 42 days postpartum.
  • Analysis of International Classification of Diseases Ninth (ICD-9) and Tenth Revision (ICD-10) codes, with and without blood transfusion data.

Main Results:

  • The study analyzed 594,056 deliveries.
  • Inclusion of prenatal and postpartum hospitalizations increased SMM case identification by 21.9%.
  • Sepsis was the leading cause of increased morbidity detection in the extended periods.

Conclusions:

  • Expanding SMM surveillance to include prenatal and postpartum hospitalizations significantly improves case ascertainment.
  • Healthcare quality surveillance should encompass the entire perinatal period, not just the delivery event.
  • This broader approach is essential for a more accurate understanding and management of severe maternal morbidity.