Severe maternal morbidity during delivery hospitalisation in a large international administrative database, 2008–2013: a retrospective cohort

Lipkind, HS; Zuckerwise, LC; Turner, EB; Collins, JJ; Campbell, K.H.; Reddy, UM; Illuzi, J.L.; Merriam, AA

doi:10.1111/1471-0528.15818

Cited by 12 publications

(16 citation statements)

References 39 publications

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“…The findings from this study are consistent with a study investigating SMM hospitalizations in the United States, England, and Australia from 2008 to 2013, which found that advanced maternal age, substance use, hypertension, and diabetes were strongly associated with SMM in all three countries (Lipkind et al, 2019). Rates of women with chronic health conditions such as hypertension, cardiac disease, and diabetes in the United States are increasing (Hirshberg & Srinivas, 2017).…”

Section: Discussion Principal Findingssupporting

confidence: 89%

Association of alcohol and other substance‐related diagnoses with severe maternal morbidity

Courchesne

Smith

Zúñiga

et al. 2021

Alcoholism Clin & Exp Res

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Background: Pregnant women with a substance-related diagnosis, such as an alcohol use disorder, are a vulnerable population that may experience higher rates of severe maternal morbidity, such as hemorrhage and eclampsia, than pregnant women with no substance-related diagnosis. Methods:This retrospective cross-sectional study reviewed electronic health record data on women (aged 18-44 years) who delivered a single live birth or stillbirth at ≥ 20 weeks of gestation from March 1, 2016, to August 30, 2019. Women with and without a substance-related diagnosis were matched on key demographic characteristics, such as age, at a 1:1 ratio. Adjusting for these covariates, odds ratios and 95% confidence intervals were calculated.Results: A total of 10,125 deliveries met the eligibility criteria for this study. In the matched cohort of 1,346 deliveries, 673 (50.0%) had a substance-related diagnosis, and 94 (7.0%) had severe maternal morbidity. The most common indicators in women with a substance-related diagnosis included hysterectomy (17.7%), eclampsia (15.8%), air and thrombotic embolism (11.1%), and conversion of cardiac rhythm (11.1%).Having a substance-related diagnosis was associated with severe maternal morbidity (adjusted odds ratio = 1.81 [95% CI, 1.14-2.88], p-value = 0.0126). In the independent matched cohorts by substance type, an alcohol-related diagnosis was significantly associated with severe maternal morbidity (adjusted odds ratio = 3.07 [95% CI, 1.58-5.95], p-value = 0.0009), while the patterns for stimulant-and nicotine-related diagnoses were not as well resolved with severe maternal morbidity and opioid-and cannabis-related diagnoses were not associated with severe maternal morbidity. Conclusion:We found that an alcohol-related diagnosis, although lowest in prevalence of the substance-related diagnoses, had the highest odds of severe maternal morbidity of any substance-related diagnosis assessed in this study. These findings reinforce the need to identify alcohol-related diagnoses in pregnant women early to minimize potential harm through intervention and treatment.

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Section: Discussion Principal Findingssupporting

confidence: 89%

Association of alcohol and other substance‐related diagnoses with severe maternal morbidity

Courchesne

Smith

Zúñiga

et al. 2021

Alcoholism Clin & Exp Res

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“…The highest proportion of near misses was seen among studies that used other non-WHO based criteria (30.5 per 1000 births, 95% CI 28.1, 33.0, 23 studies) ( Table 3 , Table S3). These criteria included those developed prior to the WHO criteria [25] , [26] , [27] and those using other common near miss criteria, such as the CDC-endorsed surveillance algorithm [28] . Interestingly, the proportion of near misses in studies that used The WHO criteria ( Figure 3 , Table 3 , Table S3) were much lower at 14.8 per 1000 births (95% CI 13.3 - 16.3, 32 studies).…”

Section: Resultsmentioning

confidence: 99%

Severe maternal morbidity in the Asia Pacific: a systematic review and meta-analysis

Silva

Panisi²,

Lindquist

et al. 2021

The Lancet Regional Health - Western Pacific

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Background: Monitoring rates of severe maternal morbidity (such as eclampsia and uterine rupture) is useful to assess the quality of obstetric care, particularly in low and lower-middle-income countries (LMICs). Methods:We undertook a systematic review characterising the proportion and causes of severe maternal morbidity in the Asia Pacific region. We searched Medline, Embase, Cochrane CENTRAL library and the World Health Organization Western Pacific Index database for studies in the Asia-Pacific reporting maternal morbidity/near miss using a predefined search strategy. We included cohort, case-control and cross-sectional studies published in English before September 2020. A meta-analysis was performed calculating the overall proportion of near miss events by sub-region, country, near miss definition, economic status, setting and cause using a random-effects model. Findings:We identified 26,232 articles, screened 24,306 and retrieved 454 full text articles. Of these, 197 studies spanning 27 countries were included. 13 countries in the region were not represented. There were 30,183,608 pregnancies and 100,011 near misses included. The total proportion of near miss events was 4 • 4 (95% CI 4 • 3-4 • 5) per 10 0 0 total births. The greatest proportion of near misses were found in the Western Pacific region (around Papua New Guinea) at 11 • 8 per 10 0 0 births (95% CI 6 • 6-17 • 1; I 2 96.05%). Low-income countries displayed the greatest proportion of near misses (13 • 4, 95% CI 6 • 0-20 • 7), followed by lower-middle income countries (11 • 1; 95% CI 10 • 4 -11 • 9). High-income countries had the lowest proportion (2 • 2, 95% CI 2 • 1-2 • 3). Postpartum haemorrhage was the most common near miss event (5 • 9, 95% CI 4 • 5-7 • 2), followed by eclampsia (2 • 7, 95% CI 2 • 4 -2 • 9).Interpretation: There is a high burden of severe maternal morbidity in the Asia-Pacific. LMICs are disproportionately affected. Most of the common causes are preventable. This provides an opportunity to implement targeted interventions which could have major clinical impact.

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“…[2][3][4] Severe maternal morbidity affects an estimated 15.8/1000 US births per year. 5 Unlike other similar Organization for Economic Cooperation and Development (OECD) countries, maternal mortality is not decreasing and there are marked racial inequities. 6 Black and Indigenous women in the United States are far more likely to die as a result of pregnancy than are white women.…”

Section: Introductionmentioning

confidence: 99%

“…Despite this, the US maternal mortality rate is more than double that of other countries with similar levels of economic development 2–4 . Severe maternal morbidity affects an estimated 15.8/1000 US births per year 5 . Unlike other similar Organization for Economic Cooperation and Development (OECD) countries, maternal mortality is not decreasing and there are marked racial inequities 6 .…”

Section: Introductionmentioning

confidence: 99%

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

Kennedy

Balaam

Dahlen

et al. 2020

Birth

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Background: The United States (US) spends more on health care than any other high-resource country. Despite this, their maternal and newborn outcomes are worse than all other countries with similar levels of economic development. Our purpose was to describe maternal and newborn outcomes and organization of care in four high-resource countries (Australia, Canada, the Netherlands, and United Kingdom) with consistently better outcomes and lower health care costs, and to identify opportunities for emulation and improvement in the United States. Method: We examined resources that described health care organization and financing, provider types, birth settings, national, clinical guidelines, health care policies, surveillance data, and information for consumers. We conducted interviews with country stakeholders representing the disciplines of obstetrics, midwifery, pediatrics, neonatology, epidemiology, sociology, political science, public health, and health services. The results of the analysis were compared and contrasted with the US maternity system. Results: The four countries had lower rates of maternal mortality, low birthweight, and newborn and infant death than the United States. Five commonalities were identified as follows: (1) affordable/ accessible health care, (2) a maternity workforce that emphasized midwifery care and interprofessional collaboration, (3) respectful care and maternal autonomy, (4) evidence-based guidelines on place of birth, and (5) national data collections systems. Conclusions: The findings reveal marked differences in the other countries compared to the United States. It is critical to consider the evidence for improved maternal and newborn outcomes with different models of care and to examine US cultural and structural failures that are leading to unacceptable and substandard maternal and infant outcomes.

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Severe maternal morbidity during delivery hospitalisation in a large international administrative database, 2008–2013: a retrospective cohort

Cited by 12 publications

References 39 publications

Association of alcohol and other substance‐related diagnoses with severe maternal morbidity

Association of alcohol and other substance‐related diagnoses with severe maternal morbidity

Severe maternal morbidity in the Asia Pacific: a systematic review and meta-analysis

The role of midwifery and other international insights for maternity care in the United States: An analysis of four countries

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