Trends in Maternal Morbidity Before and During Pregnancy in California

Fridman, Moshe; Korst, Lisa M.; Chow, J.; Lawton, Elizabeth; Mitchell, Connie; Gregory, Kimberly D.

doi:10.2105/ajph.2013.301583

Cited by 71 publications

(55 citation statements)

References 32 publications

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“…Some behavioural factors that were investigated, i.e. drug abuse and eating disorder, have been shown to be poorly recorded and thus could have been underreported in this study. In addition, we were limited to investigating BMI derived from self‐reported weight and height information, which has shown previously to relate to biased risk estimates of PTB .…”

Section: Discussionmentioning

confidence: 98%

“…Potential confounders were selected based on their significance in the univariable analysis ( P < 0.1) and because they have been associated with increased risk for PTB. The potential confounders included in the multivariable model were maternal age (continuous), prenatal care initiation (during first 5 months, 6 months or later/no initiation/unknown), maternal education (some high school or less, high school graduate, some college, college graduate or more), race/ethnicity (Non‐Hispanic White, Non‐Hispanic Black, Asian, Hispanic, Other), parity (nulliparous, multiparous), smoking during pregnancy (yes, no), presence of eating disorder (yes/no), anaemia (yes/no), pre‐existing diabetes (yes/no), pre‐existing hypertension (yes/no), gestational diabetes (yes/no), gestational hypertension (yes/no), placental abruption (yes/no), and maternal height (continuous) to reduce further potential residual confounding associated with the BMI algorithm . Because risk‐adjusted PTB could result from medical intervention, we compared the relation between severity of underweight and PTB in births that were spontaneous and in births that resulted from medical intervention.…”

Section: Methodsmentioning

confidence: 99%

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Women's prepregnancy underweight as a risk factor for preterm birth: a retrospective study

Girsen

Mayo

Carmichael

et al. 2016

BJOG

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Objective To investigate the distribution of known factors for preterm birth (PTB) by severity of maternal underweight; to investigate the risk adjusted relationship between severity of underweight and PTB and to assess if the relationship differed by gestational age. Design Retrospective cohort study. Setting State of California, USA. Methods Maternally linked hospital and birth certificate records of 950,356 California deliveries in 2007–2010 were analyzed. Singleton live births of women whose pre-pregnancy body mass index (BMI) was underweight (<18.5 kg/m2) or normal (18.50–24.99 kg/m2) were analyzed. Underweight BMI was further categorized as: severe (<16.00), moderate (16.00–16.99) or mild (17.00–18.49). PTB was grouped as 22–27, 28–31, 32–36 or <37 weeks (compared with 37–41 weeks). Adjusted multivariable Poisson regression modeling was used to estimate relative risk for PTB. Main outcome measures Risk of PTB. Results 72,686 (7.6%) women were underweight. Increasing severity of underweight was associated with increasing percent PTB: 7.8% (n=4421) in mild, 9.0% (n=1001) in moderate and 10.2% (475) in severe underweight. The adjusted relative risk of PTB also significantly increased: aRR=1.22 (95%CI: 1.19–1.26) in mild, aRR=1.41 (95%CI: 1.32–1.50) in moderate and aRR=1.61 (95%CI: 1.47–1.76) in severe underweight. These findings were similar in spontaneous PTB, medically indicated PTB, and the gestational age groupings. Conclusion Increasing severity of maternal pre-pregnancy underweight BMI was associated with increasing risk adjusted PTB at <37 weeks. This increasing risk was of similar magnitude in spontaneous and medically indicated births and in preterm delivery at 28–31 and at 32–36 weeks of gestation.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Women's prepregnancy underweight as a risk factor for preterm birth: a retrospective study

Girsen

Mayo

Carmichael

et al. 2016

BJOG

View full text Add to dashboard Cite

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“…11,14 Relevant maternal comorbidities, pregnancy complications, deliveryrelated procedures, and intrapartum complications were identified using the diagnosis and procedure codes from the International Classification of Diseases, Ninth Revision (ICD-9), listed in Appendix A. Comorbidities and complications were classified using previously described algorithms for identifying reliable pregnancy-related data using ICD-9 codes. [15][16][17] Available maternal characteristics included for comparison were age, race/ethnicity, primary insurance payer, median household income (in quartiles based on a patient's postal code), and maternal comorbidities. Pregnancy characteristics included multiple gestation, prior cesarean delivery, presence of preterm labor, and placental previa (encompassing all abnormal placentations).…”

Section: Methodsmentioning

confidence: 99%

A multi-state analysis of postpartum readmissions in the United States

Clapp

Little

Zheng

et al. 2016

American Journal of Obstetrics and Gynecology

170

166

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“…14 This data set has been used broadly to track maternal/child health outcomes and to assess the quality of obstetric care. 15, 16 The database includes patient discharge data (including diagnosis and procedure codes) for antepartum admissions in the 9 months prior to delivery, and linked maternal/infant admissions in the year after delivery, as well as data from the US Standard Certificate of Live Birth. Details of data linkage and quality control are described in detail elsewhere.…”

Section: Methodsmentioning

confidence: 99%

A ‘busy day’ effect on perinatal complications of delivery on weekends: a retrospective cohort study

et al. 2016

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Objective To evaluate whether busy days on a labour and delivery unit are associated with maternal and neonatal complications of childbirth in California hospitals, accounting for weekday/weekend births. Design This is a population-based retrospective cohort study. Setting Linked vital statistics/patient discharge data for California births between 2009 and 2010 from the Office of Statewide Health Planning and Development. Participants All singleton, cephalic, non-anomalous California births between 2009 and 2010 (N=724 967). Main outcomes The key exposure was high daily obstetric volume, defined as giving birth on a day when the number of births exceeded the hospital-specific 75th percentile of daily delivery volume. Outcomes were a range of maternal and neonatal complications. Results Several maternal and neonatal complications were increased on high-volume days and weekends following adjustment for maternal demographics, annual hospital birth volume and teaching hospital status. For example, compared with low-volume weekdays, the odds of Apgar <7 on low-volume weekend days and high-volume weekend days were 11% (adjusted OR (aOR) 1.11, CI 1.03 to 1.21) and 29% higher (aOR 1.29, CI 1.10 to 1.52), respectively. High volume was associated with increased odds of neonatal seizures on weekdays (aOR 1.33, CI 1.01 to 1.71) and haemorrhage on weekends (aOR 1.11, CI 1.01 to 1.22). After accounting for between-hospital variation, weekend delivery remained significantly associated with increased odds of Apgar score <7, neonatal intensive care unit admission, prolonged maternal length of stay and the odds of neonatal seizures remained increased on high-volume weekdays. Conclusions Our findings suggest that weekend delivery is a consistent risk factor for a range of perinatal complications and there may be variability in how well hospitals handle surges in volume.

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Trends in Maternal Morbidity Before and During Pregnancy in California

Abstract: The prevalence of maternal comorbidities before and during pregnancy has risen substantially in California and demonstrates racial/ethnic disparity independent of demographic shifts.

Cited by 71 publications

References 32 publications

Women's prepregnancy underweight as a risk factor for preterm birth: a retrospective study

Women's prepregnancy underweight as a risk factor for preterm birth: a retrospective study

A multi-state analysis of postpartum readmissions in the United States

A ‘busy day’ effect on perinatal complications of delivery on weekends: a retrospective cohort study

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