1044: A search for modifiable risk factors of severe maternal morbidity in hypertensive diseases of pregnancy

Abstract Background Current interest in using severe maternal morbidity (SMM) as a quality indicator for maternal healthcare will require the development of a standardized method for estimating hospital or regional SMM rates that includes adjustment and/or stratification for risk factors. Objective To perform a scoping review to identify methodological considerations and potential covariates for risk adjustment for delivery-associated SMM. Search methods Following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews, systematic searches were conducted with the entire PubMed and EMBASE electronic databases to identify publications using the key term “severe maternal morbidity.” Selection criteria Included studies required population-based cohort data and testing or adjustment of risk factors for SMM occurring during the delivery admission. Descriptive studies and those using surveillance-based data collection methods were excluded. Data collection and analysis Information was extracted into a pre-defined database. Study design and eligibility, overall quality and results, SMM definitions, and patient-, hospital-, and community-level risk factors and their definitions were assessed. Main results Eligibility criteria were met by 81 studies. Methodological approaches were heterogeneous and study results could not be combined quantitatively because of wide variability in data sources, study designs, eligibility criteria, definitions of SMM, and risk-factor selection and definitions. Of the 180 potential risk factors identified, 41 were categorized as pre-existing conditions (e.g., chronic hypertension), 22 as obstetrical conditions (e.g., multiple gestation), 22 as intrapartum conditions (e.g., delivery route), 15 as non-clinical variables (e.g., insurance type), 58 as hospital-level variables (e.g., delivery volume), and 22 as community-level variables (e.g., neighborhood poverty). Conclusions The development of a risk adjustment strategy that will allow for SMM comparisons across hospitals or regions will require harmonization regarding: a) the standardization of the SMM definition; b) the data sources and population used; and c) the selection and definition of risk factors of interest.

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SUN-641 Identifying Risk Factors Associated with Severe Maternal Morbidity Among Women with Gestational Diabetes Using Common Data Model

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1637 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Seo-Ho Cho ◽

Kwangsoo Kim

Keyword(s):

Risk Factors ◽

Gestational Diabetes ◽

Data Model ◽

Maternal Morbidity ◽

Severe Maternal Morbidity ◽

Common Data Model ◽

Logistic Regression Models ◽

Factors Associated ◽

Glucose And Lipid Metabolism ◽

Tertiary Center

Abstract Objective: To identify the risk factors associated with severe maternal morbidity among women with gestational diabetes using common data model Background: Severe maternal morbidity is an unintended, adverse outcome of the pregnancy or the process of labor and delivery that causes short and long-term consequences to women’s and infants’ health. The prevalence of severe maternal morbidity has been increasing, from 5 to 14 cases per every 1,000 births from 1994 to 2014, and is estimated to increase over time. Previous studies have shown an association between gestational diabetes and pregnancy complications including hypertension, preeclampsia, and preterm birth. We assessed the association of representative biomarkers with severe maternal morbidity among women with gestational diabetes. Methods: This cohort study used data collected from common data model database at a single tertiary center in Seoul, Korea during 2004-2019. All patients with indication of gestational diabetes were included in the study. Cases were all women who experienced severe maternal morbidity using the ICD-10 codes identified by the Centers for Disease Control and Prevention. We assessed associations between representative biomarkers and severe maternal morbidity, using t-test and multivariable logistic regression models. Results: Among 15,096 women who gave birth, the prevalence of gestational diabetes was 9.19% (n=1,388). Among those, 329 (23.7%) developed severe maternal morbidity during pregnancy. HbA1c, triglyceride, and fasting blood sugar were higher among women with severe maternal morbidity (p<0.05) and younger age showed association (p<0.01) with severe maternal morbidity. Conclusion: This study showed that gestational diabetes was highly associated with severe maternal morbidity. Blood glucose and lipid metabolism were shown to be associated factors with severe maternal morbidity among women with gestational diabetes.

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Treatment Results of Patients Followed in Intensive Care Unit in Severe Maternal Morbidity Cases

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.749 ◽

2018 ◽

Vol 24 (3) ◽

pp. 129

Author(s):

Hilal Uslu Yuvaci ◽

Tuba Duzcan ◽

Nermin Akdemir ◽

Erman Sever ◽

Selcuk Ozden ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Maternal Morbidity ◽

Care Center ◽

Tertiary Care ◽

Severe Maternal Morbidity ◽

Treatment Results ◽

Risk Pregnancy ◽

Complication Risk ◽

Hypertensive Diseases

Objective: The aim of this study was the evaluation of the characteristics and treatment results of women, who were brought to the intensive care unit due to severe obstetric morbidity, together with severe and acute complications in pregnancy.Study Design: Pregnant and puerperal women treated in the intensive care unit of a tertiary care center during two years of time were included in this study, and their files were scanned retrospectively. Patients’ demographic characteristics, length of stay, point of entry, neonatal results, birth statuses and modes of delivery, hemodynamic data, and histories were recorded. The qualitative data were evaluated by the Pearson Chi-squared, Fisher Freeman Halton, and Fisher’s Exact tests.Results: In the two-year period, 16,728 births occurred at our hospital. 68 cases among them were accompanied with severe maternal morbidity, and 2 maternal deaths were observed in our clinic. Of the cases, 58.8% (n=40) had severe hypertensive diseases, whereas 35.3% of the cases (n=24) had obstetric complications that developed due to bleeding. While 40% of the cases (n=16) with hypertension had severe pre-eclampsia, 35% of the cases (n=14) had eclampsia and 25% (n=10) had HELLP.Conclusions: The most important reasons for severe maternal morbidity are the complications related to obstetric bleeding and hypertensive diseases related to pregnancy. Early diagnosis of the obstetric complication risk factors is necessary for preventing maternal morbidity. Antenatal follow-ups and the births of high risk pregnancy patients should be performed in tertiary centers.

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Risk Factors for Progression from Severe Maternal Morbidity to Death: A National Cohort Study

PLoS ONE ◽

10.1371/journal.pone.0029077 ◽

2011 ◽

Vol 6 (12) ◽

pp. e29077 ◽

Cited By ~ 48

Author(s):

Gilles Kayem ◽

Jennifer Kurinczuk ◽

Gwyneth Lewis ◽

Shona Golightly ◽

Peter Brocklehurst ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Maternal Morbidity ◽

Severe Maternal Morbidity ◽

National Cohort

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Evaluating Iowa Severe Maternal Morbidity Trends and Maternal Risk Factors: 2009–2014

Maternal and Child Health Journal ◽

10.1007/s10995-017-2301-4 ◽

2017 ◽

Vol 21 (9) ◽

pp. 1834-1844 ◽

Cited By ~ 2

Author(s):

Brittni N. Frederiksen ◽

Catherine J. Lillehoj ◽

Debra J. Kane ◽

Dave Goodman ◽

Kristin Rankin

Keyword(s):

Risk Factors ◽

Maternal Morbidity ◽

Severe Maternal Morbidity ◽

Maternal Risk Factors ◽

Maternal Risk ◽

Morbidity Trends

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Antepartum severe maternal morbidity: A population‐based study of risk factors and delivery outcomes

Paediatric and Perinatal Epidemiology ◽

10.1111/ppe.12847 ◽

2021 ◽

Author(s):

Mégane Raineau ◽

Catherine Deneux‐Tharaux ◽

Aurélien Seco ◽

Marie‐Pierre Bonnet ◽

Keyword(s):

Risk Factors ◽

Maternal Morbidity ◽

Population Based ◽

Severe Maternal Morbidity ◽

Population Based Study ◽

Delivery Outcomes

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Predictive Factors for Severe Maternal Morbidity in Brazil: A Case-Control Study

Healthcare ◽

10.3390/healthcare9030335 ◽

2021 ◽

Vol 9 (3) ◽

pp. 335

Author(s):

Daniela Mendes dos Santos Magalhães ◽

João Marcos Bernardes ◽

Carlos Ruiz-Frutos ◽

Juan Gómez-Salgado ◽

Iracema de Mattos Paranhos Calderon ◽

...

Keyword(s):

Risk Factors ◽

Maternal Morbidity ◽

Family Income ◽

Case Control Study ◽

Complex Interventions ◽

Case Control ◽

Near Miss ◽

Severe Maternal Morbidity ◽

Socioeconomic Indicators ◽

Control Study

The maternal mortality or "maternal near miss" ratio in Brazil reflects the socioeconomic indicators as well as the healthcare quality in some areas of this country, pointing out fragile points in the health services. The aim of this study was to estimate the association of diverse variables related to pregnancy and the occurrence of Near Miss in a population of women who were cared in public maternity wards in Brazil. A case-control study was performed. The association between variables and outcomes was verified through a chi-square test. A multiple analysis was carried out, producing odds ratio (OR) estimates with values of p≤0.25 in the univariate model. The results point to the following risk factors for Severe Maternal Morbidity: non-white (<0.001, OR 2.973), family income of up to two minimum wage salaries (<0.001; OR 2.159), not having a partner (<0.001, OR 2.694), obesity (<0.001, OR 20.852), not having received pre-natal care (<0.001, OR 2.843), going to less than six prenatal appointments (<0.001, OR 3.498), undergoing an inter-hospital transfer (<0.001, OR 24.655), and the absence of labor during admission (<0.001, OR 25.205). Although the results vary, the incidence of women with potential life-threatening complications is high in Brazil, which reinforces the need to universalize more complex interventions as well as coverage of primary care. The presence of precarious socio-economic indicators and unqualified obstetric care were risk factors for Severe Maternal Morbidity.

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Trends and Risk Factors Associated with Severe Maternal Morbidity in Texas Women

Value in Health ◽

10.1016/j.jval.2018.04.1010 ◽

2018 ◽

Vol 21 ◽

pp. S147

Author(s):

CN Truong ◽

S Pathak ◽

C Ganduglia Cazaban

Keyword(s):

Risk Factors ◽

Maternal Morbidity ◽

Severe Maternal Morbidity ◽

Factors Associated ◽

Texas Women

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