Skip to main content

Advertisement

SpringerLink
Log in

Patient and hospital characteristics associated with severe maternal morbidity among postpartum readmissions

  • Article
  • Published:
Journal of Perinatology Submit manuscript

Abstract

Objective

To examine the influence of socioeconomic, clinical, and hospital characteristics on the risk of severe maternal morbidity among postpartum readmissions.

Study Design

A cross-sectional analysis was conducted using the National Inpatient Sample 2006–2012 to estimate the risk of severe maternal morbidity and identify potential risk factors. Odds ratios were calculated using multivariate logistic regression.

Results

Women aged ≥35 years (ages 35–39: OR 1.12 [CI 1.06, 1.19]; ages 40+: OR 1.27 [CI 1.17, 1.39]), non-Hispanic blacks (OR 1.16 [CI 1.10, 1.22]), and women with pre-existing medical conditions (OR 1.62 [CI 1.56, 1.68]) were at greater risk of severe maternal morbidity during postpartum readmissions. Women hospitalized outside the Northeast region (Midwest: OR 1.20 [CI 1.10, 1.30]; South: OR 1.29 [CI 1.20, 1.38]; West: OR 1.33 [CI 1.22, 1.44]) were also at increased risk.

Conclusion

The risk of severe maternal morbidity is heightened beyond delivery hospitalization for a subset of high-risk women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

The data that support the findings of this study are available from HCUP but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the corresponding author upon reasonable request and with permission of HCUP.

Code availability

The computer code generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

References

  1. Callaghan WM, Mackay AP, Berg CJ. Identification of severe maternal morbidity during delivery hospitalizations, United States, 1991-2003. Am J Obstet Gynecol. 2008;199:133.e1–8.

    Article  Google Scholar 

  2. Creanga AA, Berg CJ, Ko JY, Farr SL, Tong VT, Bruce FC, et al. Maternal mortality and morbidity in the United States: where are we now? J Womens Health. 2014;23:3–9.

    Article  Google Scholar 

  3. American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol. 2016;215:B17–22.

    Article  Google Scholar 

  4. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012;120:1029–36.

    PubMed  Google Scholar 

  5. Severe maternal morbidity: screening and review. Obstetric care consensus no. 5. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;128:e54–60.

    Article  Google Scholar 

  6. MacDorman MF, Declercq E. Trends and characteristics of United states out-of-hospital births 2004–2014: new information on risk status and access to care. Birth. 2016;43:116–24.

    Article  Google Scholar 

  7. Clapp MA, Little SE, Zheng J, Robinson JN. A multi-state analysis of postpartum readmissions in the United States. Am J Obstet Gynecol. 2016;215:113.e1–10.

    Article  Google Scholar 

  8. Geller SE, Cox SM, Callaghan WM, Berg CJ. Morbidity and mortality in pregnancy: laying the groundwork for safe motherhood. Women’s Health Issues. 2006;16:176–88.

    Article  Google Scholar 

  9. Kuklina EV, Meikle SF, Jamieson DJ, Whiteman MK, Barfield WD, Hillis SD, et al. Severe obstetric morbidity in the United States: 1998–2005. Obstet Gynecol. 2009;113:293–9.

    Article  Google Scholar 

  10. Kleppel L, Suplee PD, Stuebe AM, Bingham D. National initiatives to improve systems of postpartum care. Matern Child Health J. 2016;20:66–70.

    Article  Google Scholar 

  11. Belfort MA, Clark SL, Saade G, Kleja K, Dildy GAr, Van Veen TR, et al. Hospital readmission after delivery: evidence for an increased incidence of nonurogenital infection in the immediate postpartum period. Am J Obstet Gynecol. 2010;202:35.e1–7.

    Article  Google Scholar 

  12. Gray KE, Wallace ER, Nelson KR, Reed SD, Schiff MA. Population-based study of risk factors for severe maternal morbidity. Paediatr Perinat Epidemiol. 2012;26:506–14.

    Article  Google Scholar 

  13. Optimizing postpartum care. Committee opinion no. 736. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;131:e140–50.

    Article  Google Scholar 

  14. HCUP Databases. Healthcare Cost and Utilization Project—overview of the National (Nationwide) Inpatient Sample (NIS) Agency for healthcare research and quality. 2016. http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 4 Oct 2017.

  15. Kuklina EV, Whiteman MK, Hillis SD, Jamieson DJ, Meikle SF, Posner SF, et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J. 2008;12:469–77.

    Article  Google Scholar 

  16. Main EK, Abreo A, McNulty J, Gilbert W, McNally C, Poeltler D, et al. Measuring severe maternal morbidity: validation of potential measures. Am J Obstet Gynecol. 2016;214:643. e1–643.e10.

    Article  Google Scholar 

  17. Mhyre J, Bateman B, Leffert L. Influence of patient comorbidities on the risk of near-miss maternal morbidity or mortality. Anesthesiology. 2011;115:963–72.

    Article  Google Scholar 

  18. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011–2013. Obstet Gynecol. 2017;130:366–73.

    Article  Google Scholar 

  19. Admon LK, Winkelman TNA, Moniz MH, Davis MM, Heisler M, Dalton VK. Disparities in chronic conditions among women hospitalized for delivery in the United States, 2005–2014. Obstet Gynecol. 2017;130:1319–26.

    Article  Google Scholar 

  20. Lisonkova S, Potts J, Muraca GM, Razaz N, Sabr Y, Chan W-S, et al. Maternal age and severe maternal morbidity: a population-based retrospective cohort study. PLoS Med. 2017;14:e1002307.

    Article  Google Scholar 

  21. Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2016. NCHS data brief, no 287. Hyattsville, MD: National Center for Health Statistics. 2017. https://www.cdc.gov/nchs/data/databriefs/db287.pdf. Accessed 22 April 2018.

  22. Reid LD, Creanga AA. Severe maternal morbidity and related hospital quality measures in Maryland. J Perinatol. 2018;38:997–1008.

    Article  Google Scholar 

  23. Tucker MJ, Berg CJ, Callaghan WM, Hsia J. The black-white disparity in pregnancy-related mortality from 5 conditions: differences in prevalence and case-fatality rates. Am J Public Health. 2007;97:247–51.

    Article  Google Scholar 

  24. Howell EA, Egorova N, Balbierz A, Zeitlin J, Hebert PL. Black-white differences in severe maternal morbidity and site of care. Am J Obstet Gynecol. 2016;214:122.e1–7.

    Article  Google Scholar 

  25. Martin N, Montagne R The last person you’d expect to die in childbirth. ProPublica, National Public Radio. 2017. https://www.propublica.org/article/die-in-childbirth-maternal-death-rate-health-care-system. Accessed 20 April 2018.

  26. Albers L. Health problems after childbirth. J Midwifery Women's Health. 2000;45:55–7.

    Article  CAS  Google Scholar 

  27. Blenning CE, Paladine H. An approach to the postpartum office visit. Am Fam Physician. 2005;72:2491–6.

    PubMed  Google Scholar 

  28. Campbell OMR, Cegolon L, Macleod D, Benova L. Length of stay after childbirth in 92 countries and associated factors in 30 low- and middle-income countries: compilation of reported data and a cross-sectional analysis from nationally representative surveys. PLoS Med. 2016;13:e1001972.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Rutgers School of Public Health, Piscataway, NJ, USA

    Paula D. Johnson

  2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, USA

    Christina M. Duzyj

  3. Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Elizabeth A. Howell & Teresa Janevic

  4. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Elizabeth A. Howell & Teresa Janevic

  5. The Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Elizabeth A. Howell & Teresa Janevic

Authors
  1. Paula D. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina M. Duzyj
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elizabeth A. Howell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Teresa Janevic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Paula D. Johnson.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Johnson, P.D., Duzyj, C.M., Howell, E.A. et al. Patient and hospital characteristics associated with severe maternal morbidity among postpartum readmissions. J Perinatol 39, 1204–1212 (2019). https://doi.org/10.1038/s41372-019-0426-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0426-6

  • Springer Nature America, Inc.

Search

Navigation