Maternal Morbidity Risk Factors in Nulliparas.

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Epidemiology

Background:

• Severe maternal morbidity impacts 50-100 individuals in the U.S. for every maternal death.
• Identifying specific risk factors for severe maternal morbidity is challenging, especially for nulliparous individuals due to the lack of prior obstetric history.
• Understanding early pregnancy risk factors is crucial for proactive maternal care.

Purpose of the Study:

• To investigate the association between first-trimester sociodemographic factors and laboratory results with maternal morbidity in nulliparous individuals.
• To identify key predictors of severe maternal morbidity in first-time pregnancies.

Main Methods:

• Secondary analysis of a large, multicenter prospective observational cohort of nulliparas.
• Composite maternal morbidity outcome included hypertensive disorders of pregnancy, hemorrhage, infection, venous thromboembolic events, or maternal death within 14 days of delivery.
• Log-binomial regression was used to calculate adjusted relative risks and 95% confidence intervals for maternal morbidity.

Main Results:

• 18.2% of the 9,445 nulliparas analyzed experienced composite maternal morbidity.
• Hypertensive disorders of pregnancy (13.1%) and infection (4.43%) were the most common components of maternal morbidity.
• Self-identified Black race, first-trimester obesity, pregestational diabetes, chronic hypertension, and chronic kidney disease were significantly associated with increased maternal morbidity risk.

Conclusions:

• Over one in six nulliparas experience significant maternal morbidity in their first pregnancy.
• Key risk factors for maternal morbidity in nulliparas include Black race, obesity, and pre-existing conditions such as pregestational diabetes, chronic hypertension, and chronic kidney disease.
• These findings highlight the need for targeted screening and management strategies for high-risk nulliparous individuals.