Severe Maternal Morbidity in Canada: Temporal Trends and Regional Variations, 2003-2016

Dzakpasu, Susie; Deb-Rinker, Paromita; Arbour, Laura; Darling, Elizabeth; Kramer, Michael S.; Liu, Shiliang; Luo, Wei; Murphy, Phil; Nelson, Chantal; Ray, Joel G.; Scott, Heather; VandenHof, Michiel; Joseph, K. S.

doi:10.1016/j.jogc.2019.02.014

Cited by 45 publications

(61 citation statements)

References 35 publications

(25 reference statements)

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“…Surgical complications, embolism, shock, uterine rupture, severe hemorrhage, and other serious adverse obstetric outcomes (Dzakpasu et al, ).…”

Section: Resultsmentioning

confidence: 99%

“…Maternal outcomes included preeclampsia, placental abruption, placenta previa, antepartum hemorrhage, postpartum hemorrhage, oligohydramnios, polyhydramnios, gestational diabetes, sepsis and other infections, cardiovascular disorders, renal disorders, acute liver failure, severe maternal morbidity, blood transfusion, and intensive care unit admission. Severe maternal morbidity was a composite variable which included life‐threatening conditions such as shock and eclampsia (Dzakpasu et al, ). We also identified complications of labor and delivery, including cesarean delivery, breech presentation, instrumental delivery (forceps, vacuum), perineal laceration, premature rupture of membranes, precipitate labor, and other complications (failed induction of labor, abnormal forces of labor, obstructed labor, prolonged labor, retained placenta, umbilical cord complications).…”

Section: Methodsmentioning

confidence: 99%

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Pregnancy outcomes in women with anorexia nervosa

Ante

Luu

Healy‐Profitós

et al. 2020

Intl J Eating Disorders

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Objective: Birth outcomes of women with anorexia nervosa are poorly understood.We hypothesized that hospitalization for anorexia nervosa before or during pregnancy is associated with an elevated risk of adverse maternal and infant birth outcomes. Method:We performed a retrospective cohort study of 2,134,945 pregnancies in Quebec, Canada, from 1989 to 2016. The main exposure measure was anorexia nervosa requiring hospital treatment before or during pregnancy. Outcome measures included stillbirth, preterm birth, low birth weight, small-for-gestational age birth, preeclampsia, gestational diabetes, cesarean delivery, and other pregnancy disorders.We computed risk ratios and 95% confidence intervals (CI) for the association between anorexia nervosa and birth outcomes adjusted for maternal characteristics.Results: Compared with no hospitalization, anorexia nervosa hospitalization was associated with 1.99 times the risk of stillbirth (95% CI 1.20-3.30), 1.32 times the risk of preterm birth (95% CI 1.13-1.55), 1.69 times the risk of low birth weight (95% CI 1.44-1.99), and 1.52 times the risk of small-for-gestational age birth (95% CI 1.35-1.72). The associations with low birth weight and small-for-gestational age birth were more prominent in women hospitalized for anorexia nervosa during pregnancy or within 2 years of delivery. Hospitalization for anorexia nervosa was associated with certain maternal outcomes, including precipitate labor, acute liver failure, and admission to an intensive care unit.Discussion: Hospitalization for anorexia nervosa before or during pregnancy is associated with adverse infant and maternal outcomes. Infants are primarily at risk of stillbirth, preterm birth, low birth weight, and small-for-gestational age birth. K E Y W O R D Sanorexia nervosa, eating disorder, obstetric complications, pregnancy, retrospective study

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“…Surgical complications, embolism, shock, uterine rupture, severe hemorrhage, and other serious adverse obstetric outcomes (Dzakpasu et al, ).…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Pregnancy outcomes in women with anorexia nervosa

Ante

Luu

Healy‐Profitós

et al. 2020

Intl J Eating Disorders

View full text Add to dashboard Cite

show abstract

“…A recent review in New Zealand showed that at least onethird of SMM cases may be preventable, 29 and other studies have observed a high proportion of SMM due to obstetric haemorrhage. 13,17,30,31 It follows that the alleviation of anaemia in early-or mid-pregnancy might reduce both transfusion and SMMespecially those SMM elements more plausibly linked to a low haemoglobin ( Figure S1). In the present study, maternal adversity emerged at a haemoglobin concentration under 125 g/lconsiderably higher than the conventional level of 110 g/l recommended by others.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Severe maternal morbidity (SMM) offers a practical and validated proxy for maternal death (or 'near miss') and prolonged hospital length of stay, and it can be ascertained using population-based healthcare administrative data. [12][13][14][15][16] The SMM composite comprises about 40 morbidity measures arising in pregnancy, during labour or postpartum, 17 with an exponential rise in mortality as the number of SMM indicators increases. 13 If early pregnancy maternal haemoglobin concentration can identify women at risk for SMM later in pregnancy, this might naturally promote studies of interventions to reduce risk of SMM.…”

Section: Introductionmentioning

confidence: 99%

Haemoglobin levels in early pregnancy and severe maternal morbidity: population‐based cohort study

Ray

Davidson

Berger

et al. 2020

BJOG

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Objective Data regarding low maternal haemoglobin concentration and severe maternal morbidity (SMM) are limited and potentially biased. This study evaluated the relation between early maternal haemoglobin concentration and SMM or maternal mortality. Design Population-based cohort study. Setting Ontario, Canada, in a public healthcare system. Population 737 393 births with a routine outpatient haemoglobin measured at a calculated gestational age of 2-16 weeks. Methods The relation between early-pregnancy outpatient blood haemoglobin concentration and each study outcome was expressed as adjusted relative risks (aRR) and absolute risk differences (aRD), with 95% confidence intervals (CI), generated by modified Poisson regression. Main outcome measures The primary outcome was SMM or maternal mortality, from 23 weeks' gestation to 42 days postpartum. Results The mean (SD) haemoglobin concentration was 126.9 (9.3) g/l. Overall, SMM or death occurred in 13 514 pregnancies (1.8%). Relative to a haemoglobin level of 125-129 g/l, the aRR was 1.07 (95% CI 1.02-1.13) and aRD (0.09%, 95% CI 0.01-0.18) at 120-124 g/l; aRR 1.31 (95% CI 1.17-1.46) and aRD 0.47% (95% CI 0.24-0.69) at 105-109 g/l; and aRR 4.53 (95% CI 3.59-5.72) and aRD 5.94% (95% CI 4.12-7.76) at <90 g/l. In all, 5961 women (0.8%) required red cell transfusion, with significantly higher risks at all haemoglobin concentrations below 125-129 g/l, peaking at a haemoglobin level <90 g/l (aRR 11.82, 95% CI 9.30-15.03). Conclusion There is a gradual increase in the risk of SMM or death, as well as red cell transfusion, starting from the lower level of the normal range of haemoglobin of non-pregnant women.

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“…1 While maternal mortality has decreased in the developed world over the past 25 years, 2 a recent nationwide cohort study found that severe maternal morbidity (SMM) in Canada may be increasing. 3,4 The latest rate of SMM in Canada is around 17 cases per 1000 deliveries. 3…”

Section: Introductionmentioning

confidence: 99%

Association of Maternal Age With Severe Maternal Morbidity and Mortality in Canada

et al. 2019

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Key Points Question Is maternal age associated with severe maternal morbidity and with maternal death in Canada? Findings In this nationwide population-based cohort study of 3.1 million pregnancies in Canada, severe maternal morbidity has increased over the past decade, and this trend coincided with an increase over time in maternal age and in the proportion of pregnancies to older mothers. Extremes of maternal age, especially those 45 years or older compared with those aged 20 to 24 years, were associated with severe maternal morbidity and with maternal mortality. Meaning Increasing maternal age was an independent characteristic associated with severe maternal morbidity and mortality.

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Severe Maternal Morbidity in Canada: Temporal Trends and Regional Variations, 2003-2016

Cited by 45 publications

References 35 publications

Pregnancy outcomes in women with anorexia nervosa

Pregnancy outcomes in women with anorexia nervosa

Haemoglobin levels in early pregnancy and severe maternal morbidity: population‐based cohort study

Association of Maternal Age With Severe Maternal Morbidity and Mortality in Canada

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