Severe maternal morbidity from pregnancy through 1 year postpartum

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Maternal Health Research

Background:

• Limited research exists on severe maternal morbidity (SMM) beyond 42 days postpartum.
• Understanding the full spectrum of SMM risk is crucial for maternal health outcomes.

Purpose of the Study:

• To analyze SMM distribution and indicators up to 365 days postpartum.
• To quantify the increase in SMM rates by including antenatal and extended postpartum periods.
• To assess nontransfusion SMM and its extended occurrence.

Main Methods:

• Retrospective cohort study utilizing linked birth/fetal death certificates and hospital discharge records (2008-2020).
• Analysis included SMM, nontransfusion SMM, and indicators during antenatal, delivery, and postpartum hospitalizations up to 365 days.
• Calculated "added" SMM cases by comparing delivery-only vs. extended periods.

Main Results:

• 2.5% of individuals experienced SMM, and 1.4% experienced nontransfusion SMM.
• 31% of SMM cases and 49% of nontransfusion SMM cases were identified outside the delivery hospitalization (up to 365 days).
• SMM between 43-365 days postpartum accounted for 12% of all SMM cases.

Conclusions:

• A significant proportion of SMM and nontransfusion SMM occurs beyond the delivery hospitalization, up to 365 days postpartum.
• The definition of SMM should extend beyond delivery hospitalization to capture the complete risk period.
• Expanding the SMM definition is vital for identifying risk factors and developing effective mitigation strategies to improve maternal and infant outcomes.