Shields Lisa B, Glyder Angela, Chhabria Karisma, Weymouth Clayton, Cherot Elizabeth
Medical Research and Writing, Lucina Analytics, Boca Raton, USA.
Obstetrics and Gynecology, Lucina Analytics, Boca Raton, USA.
Cureus. 2025 Aug 7;17(8):e89561. doi: 10.7759/cureus.89561. eCollection 2025 Aug.
Objective Severe maternal morbidity (SMM) poses a public health dilemma. To ensure continuity of care for 12 months postpartum, the American Rescue Plan Act of 2021 permitted states to extend Medicaid postpartum coverage to 12 months. This study describes the experiences of a major national insurer in the United States. Methods A medical claims and member eligibility dataset was created from a major national insurer over a 10-year period (January 1 2014, to December 31 2023). An individual's eligibility for Medicaid insurance and ability to enroll in a major national insurer in the United States is based on several factors, including (1) age; (2) income level; (3) number of family members; and (4) whether the individual is pregnant or has a disability. The inclusion criteria in our study consisted of four qualifications: (1) the pregnancy resulted in a delivery; (2) the enrollee retained eligibility with the major national insurer for the full 365 days postpartum; (3) the enrollee did not become pregnant within 365 days postpartum; and (4) the enrollee did not die within 365 days postpartum. The total postpartum episodes refer to any pregnancy that resulted in a delivery. A postpartum episode was labeled as having an SMM when a diagnosis was observed two days prior to the delivery through 365 days postpartum. The timing of SMM was determined according to the first date of service associated with the SMM diagnosis in question. The statistical analysis was performed utilizing Wilcoxon rank sum tests for continuous variables and the chi-squared tests for categorical variables. Results Of the 105,654 total postpartum episodes, 3,396 SMM episodes were reported, reflecting 3.2% of the overall number of episodes. The most common SMM conditions were sepsis (999 (29.4%) episodes), acute respiratory distress syndrome (593 (17.5%) episodes), pulmonary edema/acute heart failure (532 (15.7%) episodes), and acute renal failure (531 (15.6%) episodes). A total of 1698 (50%) cases of all SMM presented prior to nine days, and 849 (25%) presented after 131 days. The proportion of those with an older age (29 (IQR = 24-34) years vs. 27 (IQR = 23-32) years), preterm birth (1032 (30.4%) vs. 11,817 (11.6%)), cesarean section (1769 (52.1%) vs. 33,136 (32.4%)), and a depression diagnosis within 12 months postpartum (1081 (31.8%) vs. 20,385 (19.9%)) was higher in individuals with SMM compared to individuals without SMM. Conclusion Determining the presence and specific timing of postpartum SMM is critical for intervention by case managers. Expanding Medicaid coverage through the first year postpartum offers a valuable opportunity to monitor healthcare access and manage women with potentially life-threatening pregnancy complications.
目的 严重孕产妇发病情况（SMM）构成了一个公共卫生难题。为确保产后12个月的连续护理，2021年的《美国救援计划法案》允许各州将医疗补助产后覆盖期延长至12个月。本研究描述了美国一家大型全国性保险公司的经历。方法 从一家大型全国性保险公司在10年期间（2014年1月1日至2023年12月31日）创建了一个医疗理赔和会员资格数据集。个人获得医疗补助保险的资格以及在美国加入一家大型全国性保险公司的能力基于几个因素，包括：（1）年龄；（2）收入水平；（3）家庭成员数量；以及（4）个人是否怀孕或有残疾。我们研究中的纳入标准包括四项资格：（1）怀孕导致分娩；（2）参保人在产后整整365天内保持大型全国性保险公司的资格；（3）参保人在产后365天内未怀孕；以及（4）参保人在产后365天内未死亡。产后总发作次数指任何导致分娩的怀孕情况。当在分娩前两天至产后365天观察到诊断时，产后发作被标记为患有SMM。SMM的时间根据与所讨论的SMM诊断相关的首次服务日期确定。使用Wilcoxon秩和检验对连续变量进行统计分析，使用卡方检验对分类变量进行统计分析。结果 在105,654次产后总发作中，报告了3396次SMM发作，占发作总数的3.2%。最常见的SMM情况是败血症（999例（29.4%）发作）、急性呼吸窘迫综合征（593例（17.5%）发作）、肺水肿/急性心力衰竭（532例（15.7%）发作）和急性肾衰竭（531例（15.6%）发作）。所有SMM病例中，共有1698例（50%）在九天前出现，849例（25%）在131天后出现。与无SMM的个体相比，SMM个体中年龄较大者（29岁（四分位距 = 24 - 34岁）对27岁（四分位距 = 23 - 32岁））、早产（1032例（30.4%）对11,817例（11.6%））、剖宫产（1769例（52.1%）对33,136例（32.4%））以及产后12个月内抑郁症诊断（1081例（31.8%）对20,385例（19.9%））的比例更高。结论 确定产后SMM的存在和具体时间对于个案管理人员进行干预至关重要。在产后第一年扩大医疗补助覆盖范围为监测医疗保健获取情况和管理患有可能危及生命的妊娠并发症的妇女提供了一个宝贵机会。
