Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US

Abstract

Key Points Question What proportion of de novo severe maternal morbidity is diagnosed after delivery discharge, and what are the most common factors and maternal characteristics associated with severe maternal morbidity among women in the US? Findings In this cohort study of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014, 14% and 16% of severe maternal morbidity among those with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after delivery discharge. The most common factors and maternal characteristics associated with severe maternal morbidity after delivery were different than those identified at delivery. Meaning The study’s findings suggest that expanding the focus of severe maternal morbidity assessment to the postdelivery discharge period could improve understanding of severe maternal morbidity and may create opportunities to improve maternity care.

Municipality-Level Variation in Severe Maternal Morbidity and Association With Municipal Expenditures in New Jersey

“…Following previous research on SMM, we linked the birth records to hospital discharge records from any maternal hospitalization up to 42 days 15 , 16 postpartum. 17 , 18 , 19 We kept a single birth record for each delivery regardless of plurality and limited our analysis to births in New Jersey to mothers who resided in New Jersey. We used probabilistic matching to link the records to hospital discharge files using the mother’s name, date of birth, residential address, and hospitalization dates.…”

After Childbirth: Better Data Can Help Align Postpartum Needs with a New Standard of Care

“…One-half of all cases of maternal mortality occur in the year after birth (Callaghan, Creanga, & Kuklina, 2012), and although most severe maternal morbidity occurs during childbirth, approximately 15% of these events occur between 1 and 42 days postpartum (Chen et al, 2021). Common postpartum health challenges include breastfeeding difficulties, fatigue, sexual dysfunction, pain, incontinence, and depression or anxiety, which impact almost three-quarters of all birthing people (Declercq, Sakala, Corry, Applebaum, & Herrlich, 2013).…”

Data and a Call for Action to Improve Maternal Health

“…The databases used in the analysis are not without limitations. 3 Although the commercial insurance database may provide a wider swath of the US than the Medicaid database (which covers enrollees in 9 to 13 states each year during the study period), this database lacks important demographic data about the sample. Regional differences in SMM reported from these data are insufficient to capture this demographic information.…”

“…Chen et al 3 provide a new and updated look at SMM during labor and delivery. They captured newly emerging SMM during the postpartum period using data obtained from the 2010 to 2014 IBM MarketScan Commercial Claims and Encounters database and the IBM MarketScan Multi-State Medicaid database for women aged 15 to 44 years who gave birth between January 2010 and September 2014; delivery and postpartum hospitalization data were used to measure de novo morbidity postpartum, which was defined as SMM first diagnosed after the delivery hospitalization, for deliveries sampled in the study.…”