Temporal Trend in Maternal Morbidity and Comorbidity.

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Maternal Health

Background:

• Severe maternal morbidity (SMM) is a significant public health concern.
• Trends in maternal comorbidity have been increasing, potentially impacting SMM rates.

Purpose of the Study:

• To examine temporal trends of SMM in the U.S.
• To investigate the relationship between SMM trends and maternal comorbidity trends.

Main Methods:

• Repeated cross-sectional analysis of U.S. birth certificate data (2011-2021).
• Defined SMM by ICU admission, eclampsia, hysterectomy, uterine rupture, or blood transfusion.
• Used negative binomial regression to calculate incidence rate ratios, controlling for confounders.

Main Results:

• Significant increases in maternal age, obesity, chronic hypertension, diabetes, and pregnancy-associated hypertension observed.
• Incidence of SMM rose from 0.7% to 1.0% (crude IRR 1.60).
• Pregnancy-associated hypertension was the primary comorbidity linked to increased SMM; adjusted trend for SMM was not significant.

Conclusions:

• Rising maternal comorbidity, particularly pregnancy-associated hypertension, appears to drive the increase in SMM.
• Interventions targeting the management and prevention of pregnancy-associated hypertension are crucial for reducing SMM.