Maternal Morbidity and Risk of Death at Delivery Hospitalization

Campbell, Katherine H. MD, MPH; Savitz, David PhD; Werner, Erika F. MD, MS; Pettker, Christian M. MD; Goffman, Dena MD; Chazotte, Cynthia MD; Lipkind, Heather S. MD, MS

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3182a06f4e
Original Research
Abstract

OBJECTIVE: To examine the effect of underlying maternal morbidities on the odds of maternal death during delivery hospitalization.

METHODS: We used data that linked birth certificates to hospital discharge diagnoses from singleton live births at 22 weeks of gestation or later during 1995–2003 in New York City. Maternal morbidities examined included prepregnancy weight more than 114 kilograms (250 pounds), chronic hypertension, pregestational or gestational diabetes mellitus, chronic cardiovascular disease, pulmonary hypertension, chronic lung disease, human immunodeficiency virus (HIV), and preeclampsia or eclampsia. Associations with maternal mortality were estimated using multivariate logistic regression.

RESULTS: During the specified time period, 1,084,862 live singleton births and 132 maternal deaths occurred. Patients with increasing maternal age, non-Hispanic black ethnicity, self-pay or Medicaid, primary cesarean delivery, and premature delivery had higher rates of maternal mortality during delivery hospitalization. From the entire study population, 4.1% had preeclampsia or eclampsia (n=44,004), 1.8% had chronic hypertension (n=19,647), 1.1% of patients were classified as obese (n=11,936), 0.7% had pregestational diabetes (n=7,474), 0.4% had HIV (n=4,665), and 0.01% had pulmonary hypertension (n=166). Preeclampsia or eclampsia (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 5.5–12.1), chronic hypertension (adjusted OR, 7.7; 95% CI 4.7–12.5), underlying maternal obesity (adjusted OR, 2.9; 95% CI 1.1–8.1), pregestational diabetes (adjusted OR, 3.3; 95% CI 1.3–8.1), HIV (adjusted OR, 7.7; 95% CI 3.4–17.8), and pulmonary hypertension (adjusted OR, 65.1; 95% CI 15.8–269.3) were associated with an increased risk of death during the delivery hospitalization.

CONCLUSION: The presence of maternal disease significantly increases the odds of maternal mortality at the time of delivery hospitalization.

LEVEL OF EVIDENCE: II

In Brief

There is an increased risk of maternal death at delivery hospitalization when the pregnancy is complicated by common medical conditions.

Author Information

Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, Yale School of Medicine, New Haven, Connecticut; the Departments of Epidemiology and Obstetrics and Gynecology, Brown University, Providence, Rhode Island; the Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, New York, New York.

Corresponding author: Dr. Katherine Campbell, Yale School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Science, 333 Cedar Street, Post Office Box 208063, New Haven CT; e-mail: katherine.campbell@yale.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Teresa Janevick, MHP, PhD, of the University of Medicine and Dentistry of New Jersey School of Public Health for assistance with the statistical analysis.

Presented at the Society for Maternal-Fetal Medicine 32nd Annual Meeting, February 6–11, 2012, Dallas, Texas.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.