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Am J Perinatol 2024; 41(S 01): e1878-e1884
DOI: 10.1055/a-2088-2586
Original Article

Maternal Morbidity Risk Factors in Nulliparas

Audrey A. Merriam
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, Connecticut
,
Torri D. Metz
2   Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Amanda A. Allshouse
2   Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
Robert M. Silver
2   Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah
,
David M. Haas
3   Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana
,
William A. Grobman
4   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Hyagriv N. Simhan
5   Department of Obstetrics and Gynecology, The University of Pittsburgh, Pittsburgh, Pennsylvania
,
Ronald J. Wapner
6   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Deborah Wing
7   Department of Obstetrics and Gynecology, University of California-Irvine, Irvine, California
,
Brian M. Mercer
8   Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio
,
Samuel Parry
9   Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
,
Uma M. Reddy
6   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
+nuMoM2b Investigators› Institutsangaben
Funding The findings presented in this paper were not supported by any research funding. The original NuMom2b trial was funded through the National Institute of Child Health and Human Development.
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Abstract

Objective For every incidence of maternal mortality, maternal morbidity is thought to occur in another 50 to 100 individuals in the United States. Multiple risk factors for severe maternal morbidity have been identified, but counseling about specific risk in pregnancy remains difficult, particularly nulliparous individuals as prior obstetric history is one of the factors influencing risk for severe maternal morbidity. The objective of this study is to examine the association between sociodemographic and laboratory assessments in the first trimester and maternal morbidity in nulliparas.

Study Design This was a secondary analysis of a large, multicenter prospective observational cohort of nulliparas. The primary maternal outcome was a composite of hypertensive disorders of pregnancy (HDP), hemorrhage (transfusion, hemorrhage, hysterectomy, other surgery, readmission for bleeding), infection (endometritis, wound infection or dehiscence, pneumonia, sepsis, infection during labor and delivery, readmission for infection through day 14), venous thromboembolic events (VTE) (deep venous thrombosis, or pulmonary embolus), or maternal death within 14 days of delivery. Sociodemographic and clinical factors were compared between people with and without maternal morbidity. Relative risk and 95% confidence interval for maternal morbidity was calculated using log-binomial regression, adjusted for baseline characteristics that had a significant independent relationship with maternal morbidity with a p-value <0.05.

Results Of 9,445 pregnant people in the analysis, 18.2% (n = 1,716) experienced the composite maternal morbidity; the most common component was HDP (13.1%, n = 1,244) followed by infection (4.43%, n = 420), hemorrhage (2.27%, n = 215), VTE (0.12%, n = 11), and death (0.01%, n = 1). In a multivariable model, self-identified Black race, first trimester obesity, pregestational diabetes, chronic hypertension, and chronic kidney disease were significantly associated with the primary maternal outcome.

Conclusion More than one in six nulliparas experienced the composite maternal morbidities. Maternal morbidity was associated with self-identified Black race, obesity, and multiple preexisting medical comorbidities.

Key Points

  • One in six nulliparas experience maternal morbidity in their first pregnancy related to hypertensive disorders of pregnancy, infection, hemorrhage, and venous thromboembolism.

  • Risk factors for maternal morbidity in nulliparas include Black race, prepregnancy body mass index, and preexisting medical conditions.

  • The preexisting medical conditions with the strongest association with maternal morbidity included pregestational diabetes, chronic hypertension, and chronic kidney disease.

Keywords

maternal morbidity - severe maternal morbidity - epidemiology - nulliparas - infection - hemorrhage - venous thromboembolism - hypertension

Note

This work was presented at the Poster Session of the Society for Maternal Fetal Medicine (SMFM) Virtual 41st Annual Meeting on January 28 to 30, 2021.




Publikationsverlauf

Eingereicht: 12. Oktober 2022

Angenommen: 03. Mai 2023

Accepted Manuscript online:
07. Mai 2023

Artikel online veröffentlicht:
12. Juni 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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