Allostatic Load and Adverse Perinatal Outcomes

Lueth, Amir J.; Silver, Robert M.; Allshouse, Amanda A.; Blue, Nathan R.; Wilson, F.; Murtaugh, Maureen A.

doi:10.1016/j.ajog.2021.11.225

Cited by 2 publications

(1 citation statement)

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“…50 51 52 53 Similarly, increasing disparities noted for respiratory SMM over time among Black, U.S.-born Hispanic, and non-U.S.-born Hispanic individuals may be partially due to preexisting chronic hypertension increasing risk of severe preeclampsia and pulmonary edema. 54 55 56 This combination of findings and their precursors supports the important and complex role of other factors such as structural racism and economic inequalities in structuring risk of SMM through multiple and intersecting pathways. 41…”

Section: Discussionsupporting

confidence: 56%

Trends and Disparities in Severe Maternal Morbidity Indicator Categories during Childbirth Hospitalization in California from 1997 to 2017

El Ayadi,

Lyndon,

Kan

et al. 2023

Am J Perinatol

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Objective Severe maternal morbidity (SMM) is increasing and characterized by substantial racial and ethnic disparities. Analyzing trends and disparities across time by etiologic or organ system groups instead of an aggregated index may inform specific, actionable pathways to equitable care. We explored trends and racial and ethnic disparities in seven SMM categories at childbirth hospitalization. Study Design We analyzed California birth cohort data on all live and stillbirths ≥20 weeks gestation from 1997-2017 (n=10,580,096) using the Centers for Disease Control and Prevention’s SMM index. Cases were categorized into seven non-mutually exclusive indicator categories (cardiac, renal, respiratory, hemorrhage, sepsis, other obstetric, and other medical SMM). We compared prevalence and trends in SMM indicator categories overall and by racial and ethnic group using logistic and linear regression. Results SMM occurred in 1.16% of births and non-transfusion SMM in 0.54%. Hemorrhage SMM occurred most frequently (27 per 10,000 births), followed by other obstetric (11), respiratory (7), and sepsis, cardiac, and renal SMM (5). Hemorrhage, renal, respiratory, and sepsis SMM increased over time for all racial and ethnic groups. The largest disparities were for Black individuals, including over three-fold increased odds of other medical SMM. Renal and sepsis morbidity had the largest relative increases over time (717% and 544%). Sepsis and hemorrhage SMM had the largest absolute changes over time (17 per 10,000 increase). Disparities increased over time for respiratory SMM among Black, US-born Hispanic, and non-US-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals. Disparities decreased over time for sepsis SMM among Black individuals yet remained substantial. Conclusion Our research further supports the critical need to address SMM and disparities as a significant public health priority in the United States and suggests that examining SMM subgroups may reveal helpful nuance for understanding trends, disparities and potential needs for intervention.

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