Validation of an obstetric comorbidity index in an external population

Metcalfe, Amy; Lix, Lisa M.; Ja, Johnson; Currie, Gillian; Aw, Lyon; Bernier, François P.; Tough, SC

doi:10.1111/1471-0528.13254

Cited by 128 publications

(129 citation statements)

References 20 publications

(46 reference statements)

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“…The Obstetric Comorbidity Index, which is designed to summarize the burden of comorbid illness in pregnant women, was calculated for each woman in the cohort. 22,23 Maternal medication exposure to other potentially teratogenic medications during the first trimester was also identified, including corticosteroids, danazol, fluconazole, methimazole, propylthiouracil, and synthetic progestins. Additionally, we ascertained exposure to insulin and non-insulin diabetes medications during the three months prior to pregnancy until the end of the first trimester as a marker for diabetes severity.…”

Section: Methodsmentioning

confidence: 99%

Angiotensin-Converting Enzyme Inhibitors and the Risk of Congenital Malformations

Bateman

Patorno

Desai

et al. 2017

Obstetrics &Amp; Gynecology

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Objective To examine the association between first-trimester angiotensin-converting enzyme (ACE) inhibitor exposure and the risk for overall major congenital, cardiac, and central nervous system (CNS) malformations. Methods We used a cohort of completed pregnancies linked to liveborn infants derived from Medicaid claims from 2000 to 2010. We examined the risk of malformations associated with first-trimester exposure to an ACE inhibitor. Propensity score based methods were used to control for potential confounders including maternal demographics, medical conditions, exposure to other medications, and measures of health care utilization. Results The cohort included 1,333,624 pregnancies, of which 4,107 (0.31%) were exposed to ACE inhibitors during the first trimester. The prevalence of overall malformations in the ACE inhibitor–exposed was 5.9% versus 3.3% in the unexposed (unadjusted relative risk (RR), 1.82; 95% confidence interval (CI) 1.61 to 2.06), of cardiac malformations was 3.4% versus 1.2% (RR 2.95; 95% CI 2.50 to 3.47), and of CNS malformations was 0.27% versus 0.18% (RR 1.46; 95% CI 0.81 to 2.64). After restricting the cohort to pregnancies complicated by chronic hypertension (both exposed and unexposed) and accounting for other confounding factors, there was no significant increase in the risk for any of the outcomes assessed. Relative risks associated with first-trimester ACE inhibitor exposure were 0.89 (95% CI 0.75 to 1.06) for overall malformations, 0.95 (95% CI 0.75 to 1.21) for cardiac malformations, and 0.54 (95% CI 0.26 to 1.11) for CNS malformations. Conclusions After accounting for confounders, among women with hypertension, exposure to ACE inhibitors during the first trimester was not associated with an increased risk of major congenital malformations.

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Section: Methodsmentioning

confidence: 99%

Angiotensin-Converting Enzyme Inhibitors and the Risk of Congenital Malformations

Bateman

Patorno

Desai

et al. 2017

Obstetrics &Amp; Gynecology

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“…2,13-21 Medical, obstetric, and demographic conditions shown to be predictive of severe maternal morbidity were included in the analysis. 16,20 Based on data from the United Kingdom comorbid risk factors such as diabetes, hypertensive diseases of pregnancy, and substance abuse have also been shown to be associated with increased risk for mortality. 22,23 To summarize comorbid risk, a validated index specifically designed for use in obstetric patient populations that includes demographic and medical risk factors (such as congenital heart disease, hypertension, and diabetes) predictive of maternal death and acute organ injury was included in the adjusted models.…”

Section: Methodsmentioning

confidence: 99%

“…22,23 To summarize comorbid risk, a validated index specifically designed for use in obstetric patient populations that includes demographic and medical risk factors (such as congenital heart disease, hypertension, and diabetes) predictive of maternal death and acute organ injury was included in the adjusted models. 16,20 Risk factors included in the index are assigned a weight; patients with a score of 0 have the lowest risk of severe morbidity with increasing score associated with increased risk. In the initial study used to calculate the comorbidity index risk for severe morbidity was 0.68% with a score of 0 compared to 10.9% with a score >10.…”

Section: Methodsmentioning

confidence: 99%

Hospital delivery volume, severe obstetrical morbidity, and failure to rescue

Friedman

Ananth

Huang

et al. 2016

American Journal of Obstetrics and Gynecology

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Background In the setting of persistently high risk for maternal mortality and severe obstetric morbidity, little is known about the relationship between hospital delivery volume and maternal outcomes. Objective The objectives of this analysis were (i) to determine maternal risk for severe morbidity during delivery hospitalizations by hospital delivery volume in the United States; and (ii) to characterize, by hospital volume, the risk for mortality in the setting of severe obstetrical morbidity – a concept known as failure to rescue. Study Design This cohort study evaluated 50,433,539 delivery hospitalizations across the United States from 1998 to 2010. The main outcome measures were (i) severe morbidity defined as a composite of any one of fifteen diagnoses representative of acute organ injury and critical illness, and (ii) failure to rescue, defined as death in the setting of severe morbidity. Results The prevalence of severe morbidity rose from 471.2 to 751.5 cases per 100,000 deliveries from 1998 to 2010, an increase of 59.5%. Failure to rescue was highest in 1998 (1.5%), decreased to 0.6% in 2007, and rose to 0.9% in 2010. In models adjusted for comorbid risk and hospital factors, both low and high annualized delivery volume were associated with increased risk for failure to rescue and severe morbidity. However, the relative importance of hospital volume for both outcomes compared to other factors was relatively small. Conclusions While low and high delivery volume are associated with increased risk for both failure to rescue and severe maternal morbidity, other factors, in particular characteristics of individual centers, may be more important in determining outcomes.

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“…The score contains multiple variables including maternal age, multiple gestation, previous Caesarean section, placenta praevia and 17 other comorbidities. The score was externally validated on 5995 Canadian pregnancies between 2007 and 2008 and showed moderate discriminative ability (area under the curve 0.58–0.70) and good calibration (Brier Score 0.01–0.10) 9. 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.…”

Section: Discussionmentioning

confidence: 99%