Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US
Previous efforts to examine severe maternal morbidity (SMM) in the US have focused on delivery hospitalizations. Little is known about de novo SMM that occurs after delivery discharge. To investigate the incidence, timing, factors, and maternal characteristics associated with de novo SMM after deliv...
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| description | Previous efforts to examine severe maternal morbidity (SMM) in the US have focused on delivery hospitalizations. Little is known about de novo SMM that occurs after delivery discharge.
To investigate the incidence, timing, factors, and maternal characteristics associated with de novo SMM after delivery discharge among women in the US.
In this retrospective cohort study, data from the IBM MarketScan Multi-State Medicaid database and the IBM MarketScan Commercial Claims and Encounters database were used to construct a sample of women aged 15 to 44 years who delivered between January 1, 2010, and September 30, 2014. Severe maternal morbidity was reported by the timing of diagnosis, and the associated maternal characteristics were examined. Women in the Medicaid and commercial insurance sample were classified into 3 distinct outcome groups: (1) those without any SMM during the delivery hospitalization and the postdelivery period (reference group), (2) those who exhibited at least 1 factor associated with SMM during the delivery hospitalization, and (3) those who exhibited any factor associated with de novo SMM after delivery discharge (defined as SMM that was first diagnosed in the inpatient setting during the 6 weeks [or 42 days] after discharge from the delivery hospitalization, conditional on no factor associated with SMM being identified during delivery). Data were analyzed from February to July 2020.
Timing of SMM diagnosis.
Women with SMM were identified using diagnosis and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification for the 21 factors associated with SMM that were developed by the Centers for Disease Control and Prevention.
A total of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014 were identified; of those, 809 377 women (30.3%) had Medicaid insurance (30.3%; mean [SD] age, 25.6 [5.5] years; 51.1% White), and 1 857 948 women (69.7%; mean [SD] age, 30.6 [5.4] years; 36.4% from the southern region of the US) had commercial insurance. Among those with Medicaid insurance, 17 584 women (2.2%) experienced SMM during the delivery hospitalization, and 3265 women (0.4%) experienced de novo SMM after delivery discharge. Among those with commercial insurance, 32 079 women (1.7%) experienced SMM during the delivery hospitalization, and 5275 women (0.3%) experienced de novo SMM after hospital discharge. A total of 5275 SMM cases (14.1%) and 3265 SMM cases (15.7%) among women |
| doi_str_mv | 10.1001/jamanetworkopen.2020.36148 |
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To investigate the incidence, timing, factors, and maternal characteristics associated with de novo SMM after delivery discharge among women in the US.
In this retrospective cohort study, data from the IBM MarketScan Multi-State Medicaid database and the IBM MarketScan Commercial Claims and Encounters database were used to construct a sample of women aged 15 to 44 years who delivered between January 1, 2010, and September 30, 2014. Severe maternal morbidity was reported by the timing of diagnosis, and the associated maternal characteristics were examined. Women in the Medicaid and commercial insurance sample were classified into 3 distinct outcome groups: (1) those without any SMM during the delivery hospitalization and the postdelivery period (reference group), (2) those who exhibited at least 1 factor associated with SMM during the delivery hospitalization, and (3) those who exhibited any factor associated with de novo SMM after delivery discharge (defined as SMM that was first diagnosed in the inpatient setting during the 6 weeks [or 42 days] after discharge from the delivery hospitalization, conditional on no factor associated with SMM being identified during delivery). Data were analyzed from February to July 2020.
Timing of SMM diagnosis.
Women with SMM were identified using diagnosis and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification for the 21 factors associated with SMM that were developed by the Centers for Disease Control and Prevention.
A total of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014 were identified; of those, 809 377 women (30.3%) had Medicaid insurance (30.3%; mean [SD] age, 25.6 [5.5] years; 51.1% White), and 1 857 948 women (69.7%; mean [SD] age, 30.6 [5.4] years; 36.4% from the southern region of the US) had commercial insurance. Among those with Medicaid insurance, 17 584 women (2.2%) experienced SMM during the delivery hospitalization, and 3265 women (0.4%) experienced de novo SMM after delivery discharge. Among those with commercial insurance, 32 079 women (1.7%) experienced SMM during the delivery hospitalization, and 5275 women (0.3%) experienced de novo SMM after hospital discharge. A total of 5275 SMM cases (14.1%) and 3265 SMM cases (15.7%) among women with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after hospital discharge; of those, 3993 cases (75.7%) in the commercial insurance cohort and 2399 cases (73.5%) in the Medicaid cohort were identified in the first 2 weeks after discharge. The most common factors associated with SMM varied based on the timing of diagnosis. In the Medicaid population, non-Hispanic Black women (adjusted odds ratio [aOR], 1.53; 95% CI, 1.48-1.58), Hispanic women (aOR, 1.46; 95% CI, 1.37-1.57), and women of other races or ethnicities (aOR, 1.40; 95% CI, 1.33-1.47) had higher rates of SMM during delivery hospitalization than non-Hispanic White women; however, only the disparity between Black and White women (aOR, 1.69; 95% CI, 1.57-1.81) persisted into the postdischarge period.
In this study, 14.1% of SMM cases in the Medicaid cohort and 15.7% of SMM cases in the commercial insurance cohort first occurred after the delivery hospitalization, with notable disparities in factors and maternal characteristics associated with the development of SMM. These findings suggest a need to expand the focus of SMM assessment to the postdelivery discharge period.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2020.36148</identifier><identifier>PMID: 33528553</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adolescent ; Adult ; African Americans ; Blood Transfusion ; Cohort Studies ; Disseminated Intravascular Coagulation - epidemiology ; Disseminated Intravascular Coagulation - ethnology ; Eclampsia - epidemiology ; Eclampsia - etiology ; Embolism, Air - epidemiology ; Embolism, Air - etiology ; European Continental Ancestry Group ; Female ; Heart Arrest - epidemiology ; Heart Arrest - etiology ; Heart Failure - epidemiology ; Heart Failure - etiology ; Hispanic Americans ; Hispanic people ; Hospitalization ; Humans ; Incidence ; Insurance, Health ; Maternal Age ; Medicaid ; Morbidity ; Obstetrics and Gynecology ; Online Only ; Original Investigation ; Patient Discharge ; Patient Readmission ; Pregnancy ; Puerperal Disorders - epidemiology ; Puerperal Disorders - ethnology ; Pulmonary Edema - epidemiology ; Pulmonary Edema - etiology ; Respiratory Distress Syndrome - epidemiology ; Respiratory Distress Syndrome - etiology ; Retrospective Studies ; Risk Factors ; Sepsis - epidemiology ; Sepsis - etiology ; Severity of Illness Index ; Thromboembolism - epidemiology ; Thromboembolism - etiology ; Time Factors ; United States - epidemiology ; White people ; Young Adult</subject><ispartof>JAMA network open, 2021-02, Vol.4 (2), p.e2036148-e2036148</ispartof><rights>2021. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2021 Chen J et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a473t-17eb7c5041112dbd47d44644be9d42fc69388937e37e5c4cae8dbf74e8040b8a3</citedby><cites>FETCH-LOGICAL-a473t-17eb7c5041112dbd47d44644be9d42fc69388937e37e5c4cae8dbf74e8040b8a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,864,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33528553$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chen, Jiajia</creatorcontrib><creatorcontrib>Cox, Shanna</creatorcontrib><creatorcontrib>Kuklina, Elena V</creatorcontrib><creatorcontrib>Ferre, Cynthia</creatorcontrib><creatorcontrib>Barfield, Wanda</creatorcontrib><creatorcontrib>Li, Rui</creatorcontrib><title>Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Previous efforts to examine severe maternal morbidity (SMM) in the US have focused on delivery hospitalizations. Little is known about de novo SMM that occurs after delivery discharge.
To investigate the incidence, timing, factors, and maternal characteristics associated with de novo SMM after delivery discharge among women in the US.
In this retrospective cohort study, data from the IBM MarketScan Multi-State Medicaid database and the IBM MarketScan Commercial Claims and Encounters database were used to construct a sample of women aged 15 to 44 years who delivered between January 1, 2010, and September 30, 2014. Severe maternal morbidity was reported by the timing of diagnosis, and the associated maternal characteristics were examined. Women in the Medicaid and commercial insurance sample were classified into 3 distinct outcome groups: (1) those without any SMM during the delivery hospitalization and the postdelivery period (reference group), (2) those who exhibited at least 1 factor associated with SMM during the delivery hospitalization, and (3) those who exhibited any factor associated with de novo SMM after delivery discharge (defined as SMM that was first diagnosed in the inpatient setting during the 6 weeks [or 42 days] after discharge from the delivery hospitalization, conditional on no factor associated with SMM being identified during delivery). Data were analyzed from February to July 2020.
Timing of SMM diagnosis.
Women with SMM were identified using diagnosis and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification for the 21 factors associated with SMM that were developed by the Centers for Disease Control and Prevention.
A total of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014 were identified; of those, 809 377 women (30.3%) had Medicaid insurance (30.3%; mean [SD] age, 25.6 [5.5] years; 51.1% White), and 1 857 948 women (69.7%; mean [SD] age, 30.6 [5.4] years; 36.4% from the southern region of the US) had commercial insurance. Among those with Medicaid insurance, 17 584 women (2.2%) experienced SMM during the delivery hospitalization, and 3265 women (0.4%) experienced de novo SMM after delivery discharge. Among those with commercial insurance, 32 079 women (1.7%) experienced SMM during the delivery hospitalization, and 5275 women (0.3%) experienced de novo SMM after hospital discharge. A total of 5275 SMM cases (14.1%) and 3265 SMM cases (15.7%) among women with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after hospital discharge; of those, 3993 cases (75.7%) in the commercial insurance cohort and 2399 cases (73.5%) in the Medicaid cohort were identified in the first 2 weeks after discharge. The most common factors associated with SMM varied based on the timing of diagnosis. In the Medicaid population, non-Hispanic Black women (adjusted odds ratio [aOR], 1.53; 95% CI, 1.48-1.58), Hispanic women (aOR, 1.46; 95% CI, 1.37-1.57), and women of other races or ethnicities (aOR, 1.40; 95% CI, 1.33-1.47) had higher rates of SMM during delivery hospitalization than non-Hispanic White women; however, only the disparity between Black and White women (aOR, 1.69; 95% CI, 1.57-1.81) persisted into the postdischarge period.
In this study, 14.1% of SMM cases in the Medicaid cohort and 15.7% of SMM cases in the commercial insurance cohort first occurred after the delivery hospitalization, with notable disparities in factors and maternal characteristics associated with the development of SMM. These findings suggest a need to expand the focus of SMM assessment to the postdelivery discharge period.</description><subject>Adolescent</subject><subject>Adult</subject><subject>African Americans</subject><subject>Blood Transfusion</subject><subject>Cohort Studies</subject><subject>Disseminated Intravascular Coagulation - epidemiology</subject><subject>Disseminated Intravascular Coagulation - ethnology</subject><subject>Eclampsia - epidemiology</subject><subject>Eclampsia - etiology</subject><subject>Embolism, Air - epidemiology</subject><subject>Embolism, Air - etiology</subject><subject>European Continental Ancestry Group</subject><subject>Female</subject><subject>Heart Arrest - epidemiology</subject><subject>Heart Arrest - etiology</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - etiology</subject><subject>Hispanic Americans</subject><subject>Hispanic people</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Incidence</subject><subject>Insurance, Health</subject><subject>Maternal Age</subject><subject>Medicaid</subject><subject>Morbidity</subject><subject>Obstetrics and Gynecology</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Patient Discharge</subject><subject>Patient Readmission</subject><subject>Pregnancy</subject><subject>Puerperal Disorders - epidemiology</subject><subject>Puerperal Disorders - ethnology</subject><subject>Pulmonary Edema - epidemiology</subject><subject>Pulmonary Edema - etiology</subject><subject>Respiratory Distress Syndrome - epidemiology</subject><subject>Respiratory Distress Syndrome - etiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Sepsis - epidemiology</subject><subject>Sepsis - etiology</subject><subject>Severity of Illness Index</subject><subject>Thromboembolism - epidemiology</subject><subject>Thromboembolism - etiology</subject><subject>Time Factors</subject><subject>United States - epidemiology</subject><subject>White people</subject><subject>Young Adult</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkV1LHDEUhkOpVFn9CyW0N73ZbTL5mJleFBatVlC8sOJlyCRndrOdSbZJVlnojzdbragQSDh5zns-XoQ-UTKjhNCvKz1qD_k-xN9hDX5WkYrMmKS8eYcOKlHzKWuIeP_ivY-OUloRUkDKWik-oH3GRNUIwQ7Q33lKkNIIPuPQ43NvnAVvAGtv8ak2OcSECxOM0xksvnV5ia_hDiLgyxKJXg_4MsTOWZe3eN6XED6BwRVii09cMksdF4DnY_ALfBtKIew8zkvAN9eHaK_XQ4Kjp3uCbk5__Dr-Ob24Ojs_nl9MNa9ZntIautoIwimlle0sry3nkvMOWsur3siWNU3LaihHGG40NLbraw4N4aRrNJug74-66003gjVl2KgHtY5u1HGrgnbq9Y93S7UId6puhBSlhwn68iQQw58NpKzGMhkMQ7EibJKqeNkmFawVBf38Bl2FzW5LhZKyCLZMykJ9e6RMDClF6J-boUTtfFZvfFY7n9U_n0vyx5fjPKf-d5U9AJhOqtQ</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Chen, Jiajia</creator><creator>Cox, Shanna</creator><creator>Kuklina, Elena V</creator><creator>Ferre, Cynthia</creator><creator>Barfield, Wanda</creator><creator>Li, Rui</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210201</creationdate><title>Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US</title><author>Chen, Jiajia ; Cox, Shanna ; Kuklina, Elena V ; Ferre, Cynthia ; Barfield, Wanda ; Li, Rui</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a473t-17eb7c5041112dbd47d44644be9d42fc69388937e37e5c4cae8dbf74e8040b8a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>African Americans</topic><topic>Blood Transfusion</topic><topic>Cohort Studies</topic><topic>Disseminated Intravascular Coagulation - epidemiology</topic><topic>Disseminated Intravascular Coagulation - ethnology</topic><topic>Eclampsia - epidemiology</topic><topic>Eclampsia - etiology</topic><topic>Embolism, Air - epidemiology</topic><topic>Embolism, Air - etiology</topic><topic>European Continental Ancestry Group</topic><topic>Female</topic><topic>Heart Arrest - epidemiology</topic><topic>Heart Arrest - etiology</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - etiology</topic><topic>Hispanic Americans</topic><topic>Hispanic people</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Incidence</topic><topic>Insurance, Health</topic><topic>Maternal Age</topic><topic>Medicaid</topic><topic>Morbidity</topic><topic>Obstetrics and Gynecology</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Patient Discharge</topic><topic>Patient Readmission</topic><topic>Pregnancy</topic><topic>Puerperal Disorders - epidemiology</topic><topic>Puerperal Disorders - ethnology</topic><topic>Pulmonary Edema - epidemiology</topic><topic>Pulmonary Edema - etiology</topic><topic>Respiratory Distress Syndrome - epidemiology</topic><topic>Respiratory Distress Syndrome - etiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Sepsis - epidemiology</topic><topic>Sepsis - etiology</topic><topic>Severity of Illness Index</topic><topic>Thromboembolism - epidemiology</topic><topic>Thromboembolism - etiology</topic><topic>Time Factors</topic><topic>United States - epidemiology</topic><topic>White people</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chen, Jiajia</creatorcontrib><creatorcontrib>Cox, Shanna</creatorcontrib><creatorcontrib>Kuklina, Elena V</creatorcontrib><creatorcontrib>Ferre, Cynthia</creatorcontrib><creatorcontrib>Barfield, Wanda</creatorcontrib><creatorcontrib>Li, Rui</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chen, Jiajia</au><au>Cox, Shanna</au><au>Kuklina, Elena V</au><au>Ferre, Cynthia</au><au>Barfield, Wanda</au><au>Li, Rui</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>4</volume><issue>2</issue><spage>e2036148</spage><epage>e2036148</epage><pages>e2036148-e2036148</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Previous efforts to examine severe maternal morbidity (SMM) in the US have focused on delivery hospitalizations. Little is known about de novo SMM that occurs after delivery discharge.
To investigate the incidence, timing, factors, and maternal characteristics associated with de novo SMM after delivery discharge among women in the US.
In this retrospective cohort study, data from the IBM MarketScan Multi-State Medicaid database and the IBM MarketScan Commercial Claims and Encounters database were used to construct a sample of women aged 15 to 44 years who delivered between January 1, 2010, and September 30, 2014. Severe maternal morbidity was reported by the timing of diagnosis, and the associated maternal characteristics were examined. Women in the Medicaid and commercial insurance sample were classified into 3 distinct outcome groups: (1) those without any SMM during the delivery hospitalization and the postdelivery period (reference group), (2) those who exhibited at least 1 factor associated with SMM during the delivery hospitalization, and (3) those who exhibited any factor associated with de novo SMM after delivery discharge (defined as SMM that was first diagnosed in the inpatient setting during the 6 weeks [or 42 days] after discharge from the delivery hospitalization, conditional on no factor associated with SMM being identified during delivery). Data were analyzed from February to July 2020.
Timing of SMM diagnosis.
Women with SMM were identified using diagnosis and procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification for the 21 factors associated with SMM that were developed by the Centers for Disease Control and Prevention.
A total of 2 667 325 women in the US with delivery hospitalizations between 2010 and 2014 were identified; of those, 809 377 women (30.3%) had Medicaid insurance (30.3%; mean [SD] age, 25.6 [5.5] years; 51.1% White), and 1 857 948 women (69.7%; mean [SD] age, 30.6 [5.4] years; 36.4% from the southern region of the US) had commercial insurance. Among those with Medicaid insurance, 17 584 women (2.2%) experienced SMM during the delivery hospitalization, and 3265 women (0.4%) experienced de novo SMM after delivery discharge. Among those with commercial insurance, 32 079 women (1.7%) experienced SMM during the delivery hospitalization, and 5275 women (0.3%) experienced de novo SMM after hospital discharge. A total of 5275 SMM cases (14.1%) and 3265 SMM cases (15.7%) among women with commercial and Medicaid insurance, respectively, developed de novo within 6 weeks after hospital discharge; of those, 3993 cases (75.7%) in the commercial insurance cohort and 2399 cases (73.5%) in the Medicaid cohort were identified in the first 2 weeks after discharge. The most common factors associated with SMM varied based on the timing of diagnosis. In the Medicaid population, non-Hispanic Black women (adjusted odds ratio [aOR], 1.53; 95% CI, 1.48-1.58), Hispanic women (aOR, 1.46; 95% CI, 1.37-1.57), and women of other races or ethnicities (aOR, 1.40; 95% CI, 1.33-1.47) had higher rates of SMM during delivery hospitalization than non-Hispanic White women; however, only the disparity between Black and White women (aOR, 1.69; 95% CI, 1.57-1.81) persisted into the postdischarge period.
In this study, 14.1% of SMM cases in the Medicaid cohort and 15.7% of SMM cases in the commercial insurance cohort first occurred after the delivery hospitalization, with notable disparities in factors and maternal characteristics associated with the development of SMM. These findings suggest a need to expand the focus of SMM assessment to the postdelivery discharge period.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>33528553</pmid><doi>10.1001/jamanetworkopen.2020.36148</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Adolescent Adult African Americans Blood Transfusion Cohort Studies Disseminated Intravascular Coagulation - epidemiology Disseminated Intravascular Coagulation - ethnology Eclampsia - epidemiology Eclampsia - etiology Embolism, Air - epidemiology Embolism, Air - etiology European Continental Ancestry Group Female Heart Arrest - epidemiology Heart Arrest - etiology Heart Failure - epidemiology Heart Failure - etiology Hispanic Americans Hispanic people Hospitalization Humans Incidence Insurance, Health Maternal Age Medicaid Morbidity Obstetrics and Gynecology Online Only Original Investigation Patient Discharge Patient Readmission Pregnancy Puerperal Disorders - epidemiology Puerperal Disorders - ethnology Pulmonary Edema - epidemiology Pulmonary Edema - etiology Respiratory Distress Syndrome - epidemiology Respiratory Distress Syndrome - etiology Retrospective Studies Risk Factors Sepsis - epidemiology Sepsis - etiology Severity of Illness Index Thromboembolism - epidemiology Thromboembolism - etiology Time Factors United States - epidemiology White people Young Adult |
| title | Assessment of Incidence and Factors Associated With Severe Maternal Morbidity After Delivery Discharge Among Women in the US |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T19%3A18%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Assessment%20of%20Incidence%20and%20Factors%20Associated%20With%20Severe%20Maternal%20Morbidity%20After%20Delivery%20Discharge%20Among%20Women%20in%20the%20US&rft.jtitle=JAMA%20network%20open&rft.au=Chen,%20Jiajia&rft.date=2021-02-01&rft.volume=4&rft.issue=2&rft.spage=e2036148&rft.epage=e2036148&rft.pages=e2036148-e2036148&rft.issn=2574-3805&rft.eissn=2574-3805&rft_id=info:doi/10.1001/jamanetworkopen.2020.36148&rft_dat=%3Cproquest_pubme%3E2485515395%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2667859366&rft_id=info:pmid/33528553&rfr_iscdi=true |