The Obstetric Comorbidity Index predicts severe maternal morbidity

Bateman, B.T.; Gagne, JJ

doi:10.1111/1471-0528.13297

Cited by 15 publications

(13 citation statements)

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“…Despite the low sensitivity of the maternal comorbidity index to predict SMM, the c-statistic of the maternal comorbidity index was similar to the original study that developed the index (area under the curve = 0.66) 12 and the validation study (area under the curve = 0.67). 14 In addition, clinical use for the index is promising and has been validated in a prospective clinical study (c-statistic = 0.83) 13,15 ; however, the clinical study modified the comorbidity index to include conditions that have been shown to be associated with SMM, such as prepregnancy obesity and morbidly adherent placenta. The authors of the current study also agree that the maternal comorbidity index score needs to be modified to include these other comorbid conditions, including individual-level social risk factors and hospital-level factors to appropriately flag women that are at high risk for adverse birth outcomes, when used in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 It can also be used to track patients' burden of comorbidities across practitioners, institutions, and geographic level. 13 The maternal comorbidity index has been validated in multiple studies, including one study conducted in a hospital in Alberta, Canada, 14 and one study conducted in a single, tertiary-care, academic hospital in the United States, 15 both using clinical data linked to hospital administrative data; however, both noted that the generalizability of the index was unknown and needed to be examined. In addition, a national study examined the association between maternal comorbidity index and SMM using hospital administrative data, but they limited their sample to only low-delivery-volume (<1000) hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Salahuddin

Mandell

Lakey

et al. 2019

Birth

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Background Severe maternal morbidity (SMM) prevalence was 194.0 per 10 000 deliveries in Texas in 2015. Chronic, behavioral, and pregnancy‐induced conditions, as captured by a maternal comorbidity index, increase the risk for delivery‐related morbidity and mortality. The objective of the study was to examine the association between maternal comorbidity index and SMM among delivery hospitalizations in Texas. Methods Delivery‐related hospitalizations among Texan women aged 15‐49 years were identified using the 2011‐2014 Texas all‐payer inpatient hospitalization public use data files (n = 1 434 441). The primary outcome of interest was SMM, based on the Alliance for Innovation on Maternal Health's coding scheme. The exposure of interest was a maternal comorbidity index. Multivariable logistic regression model was used to examine the association between maternal comorbidity index and SMM. Results SMM prevalence remained consistent between 2011 and 2014 (196.0‐197.0 per 10 000 deliveries, P > .05; n = 1 434 441). Nearly 40% of delivery‐related hospitalizations had a maternal comorbidity index of at least 1, and the proportion of deliveries in the highest risk category of comorbidity index (≥5) increased by 12.0% from 2011 to 2014. SMM prevalence was highest among the youngest and oldest age groups. With each unit increase in maternal comorbidity index, the odds of SMM increase was 1.43 (95% CI 1.42‐1.43). Conclusions Maternal comorbidity index is associated with SMM; however, the low predictive power of the model suggests that other, unmeasured factors may influence SMM in Texas. These findings highlight a need to understand broader contextual factors (practitioner, facility, systems of care, and community) that may be associated with SMM to reduce maternal morbidity and mortality in Texas.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Salahuddin

Mandell

Lakey

et al. 2019

Birth

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“…This score in our case was 8, which would indicate a 6.5% risk of end-organ damage or death (vs 0.7% at score 0) and 1.5% risk of maternal ICU admission (vs 0.2% at score 0) up to 30 days postpartum. The score could be used when booking pregnancies to refer patients to appropriate specialist services or tertiary care centres 10. Furthermore, the use of this score could be used as a comparative research tool 10…”

Section: Discussionmentioning

confidence: 99%

21st century obstetrics: a 50-year-old nullip—walk in the park?

Nair¹,

Gopal

Singh

2018

BMJ Case Reports

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“…The Obstetric Comorbidity Index has, until now, only been validated within highly selected cohorts derived from Medicaid, a health insurance program for low‐income individuals in the USA (https://www.medicaid.gov/basic-health-program/index.html) and from one small geographic area of Canada . Validation of the index in an unselected population as well as in other health registers is, however, of high importance to determine external validity, should the Obstetric Comorbidity Index be used to inform the care of pregnant women . The Danish health registers, with complete data on all obstetric patients, due to free access to health services, are unique sources for such an assessment in a complete and unselected study population.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 Validation of the index in an unselected population as well as in other health registers is, however, of high importance to determine external validity, should the Obstetric Comorbidity Index be used to inform the care of pregnant women. [5][6][7] The Danish health registers, with complete data on all obstetric patients, due to free access to health services, are unique sources for such an assessment in a complete and unselected study population.…”

Section: Introductionmentioning

confidence: 99%

Validation of a comorbidity index for use in obstetric patients: A nationwide cohort study

Bliddal

Möller

Vinter

et al. 2019

Acta Obstet Gynecol Scand

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Introduction A previously developed Obstetric Comorbidity Index has been validated in highly selected cohorts. Validation of the index in an unselected population as well as in other health registers is, however, of high importance to determine external validity. Material and methods Using nationwide registers, we formed a nationwide cohort including completed pregnancies (both live‐ and stillborn) in Denmark from 2000 through 2014. Maternal age and 20 comorbid conditions were assessed and weighted. Outcomes were maternal end‐organ injury or death within 30 days postpartum. The index's predictive and discriminative ability was estimated by Brier score and the area under the receiver operating characteristic curve (AUC), respectively. Logistic regression analysis was used to estimate odds ratios (OR) with 95% confidence interval (CI). Results In 876 496 completed pregnancies by 527 079 women, 1.40% (n = 12 314) experienced an outcome. The majority of women (64.1%) did not have any record of a condition included in the index and only 0.3% (n = 3044) had a score >6. The incidence of an outcome increased with increasing comorbidity score from 0.9% (95% CI 0.8‐0.9) in women scoring 0% to 10.4% (95% CI 7.6‐13.9) in women scoring 9‐10. Compared with women scoring 0, a score of 1‐2 yielded an OR of 2.34 (95% CI 2.25‐2.44), 3‐4 an OR of 5.16 (95% CI 4.81‐5.54), 5‐6 an OR of 4.84 (95% CI 4.31‐5.44), and 8‐9 an OR of 7.97 (95% CI 6.54‐9.72) for experiencing the outcome. The index had a Brier score of 0.01 and an AUC of 0.64. Conclusions Despite potential weaknesses in the outcome definition, the Obstetric Comorbidity Index showed a moderate ability to discriminate and predict end‐organ injury and death in a nationwide cohort in Denmark, in accordance with previous findings. These results suggest that the index may be a useful tool to control for confounding in health research and clinically to identify women at high risk for adverse maternal outcomes.

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The Obstetric Comorbidity Index predicts severe maternal morbidity

Cited by 15 publications

References 0 publications

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

Maternal comorbidity index and severe maternal morbidity during delivery hospitalizations in Texas, 2011‐2014

21st century obstetrics: a 50-year-old nullip—walk in the park?

Validation of a comorbidity index for use in obstetric patients: A nationwide cohort study

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