Massachusetts Department of Public Health, Boston, Massachusetts.
Boston University School of Public Health, Boston, Massachusetts.
Womens Health Issues. 2024 Sep-Oct;34(5):498-505. doi: 10.1016/j.whi.2024.06.002. Epub 2024 Jul 17.
Among those with a severe maternal morbidity (SMM) event and a subsequent birth, we examined how the risk of a second SMM event varied by patient characteristics and intrapartum hospital utilization.
We used a Massachusetts population-based dataset that longitudinally linked in-state births, hospital discharge records, prior and subsequent births, and non-birth-related hospital utilizations for birthing individuals and their children from January 1, 1999, to December 31, 2018, representing 1,460,514 births by 907,530 birthing people. We restricted our study sample to 2,814 people who had their first SMM event associated with a singleton birth and gave birth a second time within the study period. Our outcome measure was recurrence of SMM in the second birth. We calculated the prevalence of SMM at second birth, compared SMM conditions between births, and estimated the adjusted risk ratios and 95% confidence intervals for having an SMM event at second birth among those who had an SMM at the first birth. We also examined overall hospital utilization including inpatient admissions, emergency room visits, and observational stays, and hospital utilization by interpregnancy intervals (IPIs) between the first and second birth.
There were 2,814 birthing people with at least one birth after the first SMM singleton birth. Among those, 198 (7.0%) had a subsequent SMM. The percentage of people with a second SMM event varied by age, race/ethnicity, insurance, IPI, and history of hypertension at first case of SMM (all p < .05). Between births, people with a second SMM event had significantly higher proportions of inpatient admissions (60.1% vs. 33.2.0%; p < .001), emergency room visits (71.7% vs. 57.7%; p < .001), and observational stays (35.4% vs. 19.5%; p < .001) compared with those who did not experience a second SMM event.
Hospital utilization after a birth with SMM might indicate an elevated risk of a second SMM event. Providers should counsel their patients about prevention and warning signs.
在患有严重产妇发病率（SMM）事件并随后分娩的人群中，我们研究了患者特征和分娩期间医院利用情况如何影响第二次 SMM 事件的风险。
我们使用了马萨诸塞州的一个基于人群的数据集，该数据集从 1999 年 1 月 1 日至 2018 年 12 月 31 日，纵向链接了本州出生、医院出院记录、前后分娩以及分娩个体及其子女的非分娩相关医院利用情况，代表了 907530 名分娩者的 1460514 次分娩。我们将研究样本限制在 2814 名首次 SMM 事件与单胎分娩相关且在研究期间再次分娩的人群中。我们的结局指标是第二次分娩中 SMM 的复发。我们计算了第二次分娩中 SMM 的患病率，比较了两次分娩中 SMM 的情况，并估计了在第一次分娩中发生 SMM 的人群中第二次分娩中发生 SMM 事件的调整风险比和 95%置信区间。我们还检查了包括住院、急诊就诊和观察性住院在内的总体医院利用情况，以及两次分娩之间的妊娠间隔（IPI）的医院利用情况。
在至少有一次首次 SMM 单胎分娩后的 2814 名分娩者中，有 198 人（7.0%）随后发生了 SMM。第二次 SMM 事件的人群比例因年龄、种族/民族、保险、IPI 和首次 SMM 病例中的高血压史而异（均 p<0.05）。与未发生第二次 SMM 事件的人群相比，发生第二次 SMM 事件的人群住院率（60.1% vs. 33.2.0%；p<0.001）、急诊就诊率（71.7% vs. 57.7%；p<0.001）和观察性住院率（35.4% vs. 19.5%；p<0.001）均显著更高。
SMM 分娩后的医院利用情况可能表明再次发生 SMM 事件的风险升高。提供者应向患者提供有关预防和预警信号的咨询。
