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Association between gestational age at delivery and indicator-specific severe maternal morbidity
Jaclyn M Phillips1, Lisa M Bodnar2,3, Katherine P Himes1,2
1Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Summary
Severe maternal morbidity is significantly higher in preterm births, especially before 28 weeks gestation. Specific indicators of severe maternal morbidity differ between preterm and term deliveries.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Perinatal Research
Background:
- Severe maternal morbidity (SMM) disproportionately affects individuals delivering preterm.
- Limited data exist on how SMM indicators vary by gestational age at delivery.
Purpose of the Study:
- To evaluate the relationship between gestational age at delivery and the incidence of SMM.
- To analyze indicator-specific SMM across different gestational age epochs.
Main Methods:
- Analysis of a hospital administrative delivery database (2002-2018) for singleton deliveries (16-42 weeks gestation).
- SMM defined by ICD codes, ICU admission, or prolonged postpartum stay.
- Gestational age categorized into: extremely preterm (<28 weeks), preterm (28-36 weeks), and term (≥37 weeks).
- Multivariable binomial regression adjusted for confounders (age, BMI, insurance, comorbidities).
Main Results:
- Overall SMM incidence was 2.5%.
- Unadjusted SMM rates: 12% (<28 weeks), 8.4% (28-36 weeks), 1.7% (≥37 weeks).
- Adjusted analysis showed predicted SMM probability of 16% at 24 weeks vs. 2.2% at 38 weeks.
- Common SMM indicators <28 weeks: sepsis, ARDS, mechanical ventilation, shock.
- Common SMM indicators ≥37 weeks: heart failure, cardiac arrhythmias.
Conclusions:
- A substantial proportion of SMM occurs in preterm deliveries, peaking at <28 weeks gestation.
- Distinct patterns of SMM indicators exist for preterm versus term deliveries.
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