Association between stillbirth and severe maternal morbidity.

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Perinatal Epidemiology

Background:

• Severe maternal morbidity (SMM) rates have been rising globally.
• Limited research exists on the association between stillbirth and SMM.
• Understanding this link is crucial for improving maternal outcomes.

Purpose of the Study:

• To investigate the prevalence and risk of SMM in individuals experiencing stillbirth compared to live-birth deliveries.
• To analyze SMM during delivery hospitalization and the postpartum period.
• To quantify the association between stillbirth and SMM using robust statistical methods.

Main Methods:

• Retrospective cohort study utilizing linked birth/fetal death certificates and hospital discharge records.
• Inclusion of data from five US states (California, Michigan, Missouri, Pennsylvania, South Carolina) spanning 2008-2020.
• Relative risk regression analysis to determine adjusted relative risks for SMM, controlling for confounding variables.

Main Results:

• Stillbirth deliveries (0.40%) were associated with higher rates of SMM compared to live-birth deliveries.
• Adjusted relative risk for SMM during delivery hospitalization was 1.6 (95% CI, 1.5-1.8) for stillbirths.
• Elevated SMM risk persisted up to one year postpartum (aRR 1.3 for SMM, aRR 1.2 for non-transfusion SMM).

Conclusions:

• Stillbirth is a significant independent risk factor for severe maternal morbidity.
• The increased risk of SMM extends into the postpartum period.
• Clinical attention and further research are warranted to mitigate SMM risk following stillbirth.