Risk of Severe Maternal Morbidity Associated with Maternal Comorbidity Burden and Social Vulnerability

Author:

Gulersen Moti12ORCID,Alvarez Alejandro3,Suarez Fernando1,Kouba Insaf4,Rochelson Burton1,Combs Adriann1,Nimaroff Michael1,Blitz Matthew J.4ORCID

Affiliation:

1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York

2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania

3. Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, New York

4. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, South Shore University Hospital - Zucker School of Medicine at Hofstra/Northwell, Bay Shore, New York

Abstract

Objective We evaluated the associations of the obstetric comorbidity index (OB-CMI) and social vulnerability index (SVI) with severe maternal morbidity (SMM). Study Design Multicenter retrospective cohort study of all patients who delivered (gestational age > 20 weeks) within a university health system from January 1, 2019, to December 31, 2021. OB-CMI scores were assigned to patients using clinical documentation and diagnosis codes. SVI scores, released by the Centers for Disease Control and Prevention (CDC), were assigned to patients based on census tracts. The primary outcome was SMM, based on the 21 CDC indicators. Mixed-effects logistic regression was used to model the odds of SMM as a function of OB-CMI and SVI while adjusting for maternal race and ethnicity, insurance type, preferred language, and parity. Results In total, 73,518 deliveries were analyzed. The prevalence of SMM was 4% (n = 2,923). An association between OB-CMI and SMM was observed (p < 0.001), where OB-CMI score categories of 1, 2, 3, and ≥4 were associated with higher odds of SMM compared with an OB-CMI score category of 0. In the adjusted model, there was evidence of an interaction between OB-CMI and maternal race and ethnicity (p = 0.01). After adjusting for potential confounders, including SVI, non-Hispanic Black patients had the highest odds of SMM among patients with an OB-CMI score category of 1 and ≥4 compared with non-Hispanic White patients with an OB-CMI score of 0 (adjusted odds ratio [aOR] 2.76, 95% confidence interval [CI] 2.08–3.66 and aOR 10.07, 95% CI 8.42–12.03, respectively). The association between SVI and SMM was not significant on adjusted analysis. Conclusion OB-CMI was significantly associated with SMM, with higher score categories associated with higher odds of SMM. A significant interaction between OB-CMI and maternal race and ethnicity was identified, revealing racial disparities in the odds of SMM within each higher OB-CMI score category. SVI was not associated with SMM after adjusting for confounders. Key Points

Publisher

Georg Thieme Verlag KG

Subject

Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health

Reference16 articles.

1. American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Severe maternal morbidity: screening and review;S K Kilpatrick;Am J Obstet Gynecol,2016

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3. A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery;S R Easter;Am J Obstet Gynecol,2019

4. Preterm birth among pregnant women living in areas with high social vulnerability;M Givens;Am J Obstet Gynecol MFM,2021

5. Maternal morbidity after preterm premature rupture of membranes at <24 weeks' gestation;A Sklar;Am J Obstet Gynecol,2022

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