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Am J Perinatol 2024; 41(S 01): e3341-e3350
DOI: 10.1055/a-2223-3520
Original Article

Trends and Disparities in Severe Maternal Morbidity Indicator Categories during Childbirth Hospitalization in California from 1997 to 2017

Alison M. El Ayadi 
1   Department of Obstetrics, Gynecology and Reproductive Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, California
,
Audrey Lyndon 
2   NYU Rory Meyers College of Nursing, New York, New York
,
Peiyi Kan
3   Department of Pediatrics, Stanford University School of Medicine, Stanford, California
,
Mahasin S. Mujahid
4   Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California
,
Stephanie A. Leonard
5   Department of Obstetrics and Gynecology, Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine, Stanford, California
,
Elliott K. Main
5   Department of Obstetrics and Gynecology, Dunlevie Maternal-Fetal Medicine Center, Stanford University School of Medicine, Stanford, California
,
Suzan L. Carmichael
6   Department of Pediatrics, Department of Obstetrics and Gynecology, Stanford University, Stanford, California
› Author Affiliations
Funding This study was funded by the National Institute of Nursing Research Grant R01NR017020 (PI: S.L.C.). The funders had no role in study design; collection, analysis, and interpretation of data; writing the report; and in the decision to submit the article for publication.
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Abstract

Objective Severe maternal morbidity (SMM) is increasing and characterized by substantial racial and ethnic disparities. Analyzing trends and disparities across time by etiologic or organ system groups instead of an aggregated index may inform specific, actionable pathways to equitable care. We explored trends and racial and ethnic disparities in seven SMM categories at childbirth hospitalization.

Study Design We analyzed California birth cohort data on all live and stillbirths ≥ 20 weeks' gestation from 1997 to 2017 (n = 10,580,096) using the Centers for Disease Control and Prevention's SMM index. Cases were categorized into seven nonmutually exclusive indicator categories (cardiac, renal, respiratory, hemorrhage, sepsis, other obstetric, and other medical SMM). We compared prevalence and trends in SMM indicator categories overall and by racial and ethnic group using logistic and linear regression.

Results SMM occurred in 1.16% of births and nontransfusion SMM in 0.54%. Hemorrhage SMM occurred most frequently (27 per 10,000 births), followed by other obstetric (11), respiratory (7), and sepsis, cardiac, and renal SMM (5). Hemorrhage, renal, respiratory, and sepsis SMM increased over time for all racial and ethnic groups. The largest disparities were for Black individuals, including over 3-fold increased odds of other medical SMM. Renal and sepsis morbidity had the largest relative increases over time (717 and 544%). Sepsis and hemorrhage SMM had the largest absolute changes over time (17 per 10,000 increase). Disparities increased over time for respiratory SMM among Black, U.S.-born Hispanic, and non-U.S.-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals. Disparities decreased over time for sepsis SMM among Black individuals yet remained substantial.

Conclusion Our research further supports the critical need to address SMM and disparities as a significant public health priority in the United States and suggests that examining SMM subgroups may reveal helpful nuance for understanding trends, disparities, and potential needs for intervention.

Key Points

  • By SMM subgroup, trends and racial and ethnic disparities varied yet Black individuals consistently had highest rates.

  • Hemorrhage, renal, respiratory, and sepsis SMM significantly increased over time.

  • Disparities increased for respiratory SMM among Black, U.S.-born Hispanic and non-U.S.-born Hispanic individuals and for sepsis SMM among Asian or Pacific Islander individuals.

Keywords

health equity - racial and ethnic disparities - severe maternal morbidity - maternal health - pregnancy complications - obstetric complications

Authors' Contributions

A.M.E. played a key role in conceptualization, formal analysis, investigation, methodology, visualization, and contributed to both the original draft and the subsequent review and editing. A.L. contributed significantly to conceptualization, investigation, methodology, and was involved in both the original draft and review and editing stages, providing supervision. P.K. took on responsibilities in data curation, formal analysis, investigation, methodology, visualization, and participated in writing—both the original draft and the review and editing process. M.S.M. focused on writing and reviewing. S.A.L. participated in the writing and reviewing stages. E.K.M. played a vital role in conceptualization, methodology, and contributed to the review and editing. S.L.C. took on multiple roles, including conceptualization, data curation, investigation, funding acquisition, methodology, resources, writing—both original draft and review/editing, supervision, project administration, and additional funding acquisition.


Supplementary Material



Publication History

Received: 03 September 2023

Accepted: 04 December 2023

Accepted Manuscript online:
06 December 2023

Article published online:
29 January 2024

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