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01-09-2017

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

Authors: Brittni N. Frederiksen, Catherine J. Lillehoj, Debra J. Kane, Dave Goodman, Kristin Rankin

Published in: Maternal and Child Health Journal | Issue 9/2017

Abstract

Objectives To describe statewide SMM trends in Iowa from 2009 to 2014 and identify maternal characteristics associated with SMM, overall and by age group. Methods We used 2009–2014 linked Iowa birth certificate and hospital discharge data to calculate SMM based on a 25-condition definition and 24-condition definition. The 24-condition definition parallels the 25-condition definition, but excludes blood transfusions. We calculated SMM rates for all delivery hospitalizations (N = 196,788) using ICD-9-CM diagnosis and procedure codes. We used log-binomial regression to assess the association of SMM with maternal characteristics, overall and stratified by age groupings. Results In contrast to national rates, Iowa’s 25-condition SMM rate decreased from 2009 to 2014. Based on the 25-condition definition, SMM rates were significantly higher among women <20 years and >34 years compared to women 25–34 years. Blood transfusion was the most prevalent indicator, with hysterectomy and disseminated intravascular coagulation (DIC) among the top five conditions. Based on the 24-condition definition, younger women had the lowest SMM rates and older women had the highest SMM rates. SMM rates were also significantly higher among racial/ethnic minorities compared to non-Hispanic white women. Payer was the only risk factor differentially associated with SMM across age groups. First trimester prenatal care initiation was protective for SMM in all models. Conclusions High rates of blood transfusion, hysterectomy, and DIC indicate a need to focus on reducing hemorrhage in Iowa. Both younger and older women and racial/ethnic minorities are identified as high risk groups for SMM that may benefit from special consideration and focus.

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Hospital levels of care in Iowa are based on a combination of maternal and newborn perinatal care needs and risk factors.

Aschengrau, A., & Seage, G. R. (2003). Essentials of epidemiology in public health. Jones and Bartlett Publishers, Inc.

Bediako, P. T., BeLue, R., & Hillemeier, M. M. (2015). A comparison of birth outcomes among Black, Hispanic, and Black Hispanic women. Journal of Racial and Ethnic Health Disparities, 2(4), 573–582. doi:10.1007/s40615-015-0110-2.CrossRefPubMedPubMedCentral

Berg, C. J., Chang, J., Callaghan, W. M., & Whitehead, S. J. (2003). Pregnancy-related mortality in the United States, 1991–1997. Obstetrics and Gynecology, 101(2), 289–296.PubMed

Callaghan, W. M., Creanga, A. A., & Kuklina, E. V. (2012). Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstetrics and Gynecology, 120(5), 1029–1036. doi:10.1097/AOG.0b013e31826d60c5.PubMed

Callaghan, W. M., Mackay, A. P., & Berg, C. J. (2008). Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991–2003. American Journal of Obstetrics and Gynecology, 199(2), 133e1–e8. doi:10.1016/j.ajog.2007.12.020.CrossRef

Carson, J. L., Grossman, B. J., Kleinman, S., Tinmouth, A. T., Marques, M. B., Fung, M. K., … Clinical Transfusion Medicine Committee of the AABB. (2012). Red blood cell transfusion: A clinical practice guideline from the AABB*. Annals of Internal Medicine, 157(1), 49–58. doi:10.7326/0003-4819-157-1-201206190-00429.CrossRefPubMed

Creanga, A. A., Bateman, B. T., Kuklina, E. V., & Callaghan, W. M. (2014). Racial and ethnic disparities in severe maternal morbidity: A multistate analysis, 2008–2010. American Journal of Obstetrics and Gynecology, 210(5), 435e1–e8. doi:10.1016/j.ajog.2013.11.039.CrossRef

Dominguez, T. P., Dunkel-Schetter, C., Glynn, L. M., Hobel, C., & Sandman, C. A. (2008). Racial differences in birth outcomes: the role of general, pregnancy, and racism stress. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 27(2), 194–203. doi:10.1037/0278-6133.27.2.194.CrossRef

Evans, W. N., & Lien, D. S. (2005). The benefits of prenatal care: evidence from the PAT bus strike. Journal of Econometrics, 125(1–2), 207–239. doi:10.1016/j.jeconom.2004.04.007.CrossRef

Finer, L. B., & Zolna, M. R. (2016). Declines in Unintended Pregnancy in the United States, 2008–2011. The New England Journal of Medicine, 374(9), 843–852. doi:10.1056/NEJMsa1506575.CrossRefPubMedPubMedCentral

Geller, S. E., Rosenberg, D., Cox, S. M., Brown, M. L., Simonson, L., Driscoll, C. A., & Kilpatrick, S. J. (2004). The continuum of maternal morbidity and mortality: Factors associated with severity. American Journal of Obstetrics and Gynecology, 191(3), 939–944. doi:10.1016/j.ajog.2004.05.099.CrossRefPubMed

Gray, K. E., Wallace, E. R., Nelson, K. R., Reed, S. D., & Schiff, M. A. (2012). Population-based study of risk factors for severe maternal morbidity. Paediatric and Perinatal Epidemiology, 26(6), 506–514. doi:10.1111/ppe.12011.CrossRefPubMedPubMedCentral

Kuehn, B. M. (2012). Guideline tightens transfusion criteria. JAMA, 307(17), 1788–1789. doi:10.1001/jama.2012.3728.CrossRefPubMed

Kuklina, E. V., Meikle, S. F., Jamieson, D. J., Whiteman, M. K., Barfield, W. D., Hillis, S. D., & Posner, S. F. (2009). Severe obstetric morbidity in the United States: 1998–2005. Obstetrics and Gynecology, 113(2 Pt 1), 293–299. doi:10.1097/AOG.0b013e3181954e5b.CrossRefPubMedPubMedCentral

Lindquist, A., Kurinczuk, J., Redshaw, M., & Knight, M. (2014). Experiences, utilisation and outcomes of maternity care in England among women from different socio-economic groups: Findings from the 2010 National Maternity Survey. BJOG: An International Journal of Obstetrics and Gynaecology. doi:10.1111/1471-0528.13059.

Luke, B., & Brown, M. B. (2007). Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age. Human Reproduction (Oxford, England), 22(5), 1264–1272. doi:10.1093/humrep/del522.CrossRef

Main, E. K., Abreo, A., McNulty, J., Gilbert, W., McNally, C., Poeltler, D., … Kilpatrick, S. (2015). Measuring severe maternal morbidity: Validation of potential measures. American Journal of Obstetrics and Gynecology. doi:10.1016/j.ajog.2015.11.004.

Oliveira, F. C., Surita, F. G., Pinto E Silva, J. L., Cecatti, J. G., Parpinelli, M. A., Haddad, S. M., … Brazilian Network for Surveillance of Severe Maternal Morbidity Study Group. (2014). Severe maternal morbidity and maternal near miss in the extremes of reproductive age: Results from a national cross- sectional multicenter study. BMC Pregnancy and Childbirth, 14, 77. doi:10.1186/1471-2393-14-77.CrossRefPubMedPubMedCentral

Philliber Research Associates and University of California, San Francisco Bixby Center for Global Reproductive Health. (2015). The Iowa Initiative to Reduce Unintended Pregnancies Final Report. Retrieved from https://www.training-source.org/sites/default/files/comm_value_public_health/II%20Press%20Kit%20One%20Pager%20FINAL.pdf.

Phillippi, J. C. (2009). Women’s perceptions of access to prenatal care in the United States: A literature review. Journal of Midwifery and Women’s Health, 54(3), 219–225. doi:10.1016/j.jmwh.2009.01.002.CrossRefPubMed

Registry Plus, a suite of publicly available software programs for collecting and processing cancer registry data. (2015). Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Retrieved from http://www.cdc.gov/cancer/npcr/.

Roberts, C. L., Cameron, C. A., Bell, J. C., Algert, C. S., & Morris, J. M. (2008). Measuring maternal morbidity in routinely collected health data: Development and validation of a maternal morbidity outcome indicator. Medical Care, 46(8), 786–794. doi:10.1097/MLR.0b013e318178eae4.CrossRefPubMed

Say, L., Souza, J. P., Pattinson, R. C., & WHO working group on Maternal Mortality and Morbidity classifications. (2009). Maternal near miss–towards a standard tool for monitoring quality of maternal health care. Best Practice and Research. Clinical Obstetrics and Gynaecology, 23(3), 287–296. doi:10.1016/j.bpobgyn.2009.01.007.CrossRefPubMed

Vintzileos, A. M., Ananth, C. V., Smulian, J. C., Scorza, W. E., & Knuppel, R. A. (2002a). The impact of prenatal care in the United States on preterm births in the presence and absence of antenatal high-risk conditions. American Journal of Obstetrics and Gynecology, 187(5), 1254–1257.CrossRefPubMed

Vintzileos, A. M., Ananth, C. V., Smulian, J. C., Scorza, W. E., & Knuppel, R. A. (2002b). The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions. American Journal of Obstetrics and Gynecology, 186(5), 1011–1016.CrossRefPubMed

WHO obesity and overweight. (2016). Retrieved October 19, 2016, from http://www.who.int/mediacentre/factsheets/fs311/en/.

Title: Evaluating Iowa Severe Maternal Morbidity Trends and Maternal Risk Factors: 2009–2014
Authors: Brittni N. Frederiksen
Catherine J. Lillehoj
Debra J. Kane
Dave Goodman
Kristin Rankin
Publication date: 01-09-2017
Publisher: Springer US
Published in: Maternal and Child Health Journal / Issue 9/2017
Print ISSN: 1092-7875
Electronic ISSN: 1573-6628
DOI: https://doi.org/10.1007/s10995-017-2301-4

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