Recently attention has shifted from an exclusive focus on maternal mortality toward recognition of the extensive morbidity many women experience during delivery. This study explores the prevalence and trends in severe maternal morbidity (SMM) in New York City (NYC) from 2008–2012.METHODS:
Delivery hospitalization records were linked with NYC birth certificates from 2008–2012 (n=588,232). SMM cases at delivery were identified using a national algorithm of ICD-9-CM codes. Chi square tests, Cochran-Armitage tests and logistic regression were used to examine the significance of associations and trends. The SMM rate was calculated per 10,000 deliveries.RESULTS:
The SMM rate increased 28% from 197.2 per 10,000 deliveries in 2008 to 252.9 per 10,000 deliveries in 2012, and is 1.6 times the national estimate. The leading disease-based indicators were complications of surgery or medical procedures (19.7 per 10,000 deliveries), disseminated intravascular coagulation (17.1), and adult respiratory distress syndrome (6.6). The leading procedure-based indicators were blood transfusion (176.5 per 10,000 deliveries), hysterectomy (12.5), and ventilation (11.4). SMM rates were highest among women less than 20 (292.2) or over 40 years of age (358.9), Black non-Hispanic women (386.9), and those living in high-poverty neighborhoods (282.7). Women with a major chronic condition, such as hypertension, diabetes, or heart disease, were three times as likely to have an SMM as women with no chronic conditions (628.2 vs 217.3).CONCLUSION:
Given the rising prevalence of SMM in NYC and its inequitable distribution, a robust surveillance system and ongoing research is critical for monitoring trends and elucidating risk factors.