Reproductive & Maternal Health Resource Center

Reproductive & Maternal Health Resource Center

Disclosures: Admon reports receiving grants from the Agency for Healthcare Research and Quality, American College of Obstetricians and Gynecologists, CDC Division of Reproductive Health, Commonwealth Foundation, Health Resource and Services Administration and NIH and personal fees from the Medicaid and CHIP Payment and Access Commission. Zivin reports receiving grants from the NIH. Please see the study for all other authors' relevant financial disclosures.
December 13, 2021
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Risk for maternal mortality persists during postpartum year

Disclosures: Admon reports receiving grants from the Agency for Healthcare Research and Quality, American College of Obstetricians and Gynecologists, CDC Division of Reproductive Health, Commonwealth Foundation, Health Resource and Services Administration and NIH and personal fees from the Medicaid and CHIP Payment and Access Commission. Zivin reports receiving grants from the NIH. Please see the study for all other authors' relevant financial disclosures.
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About one in 333 women experienced a severe maternal morbidity event or illness during postpartum that could have resulted in death, according to findings published in JAMA Network Open.

“High rates of maternal mortality in the U.S. are driven, in part, by an increasing number of maternal deaths occurring in the late postpartum period,” Lindsay K. Admon, MD, MSc, an OB/GYN and researcher at University of Michigan Health Von Voigtlander Women’s Hospital, told Healio Primary Care. “This study is the first to describe the type and timing of health challenges faced by mothers who require hospitalization during the full postpartum year.”

Rate of severe maternal morbidity during late postpartum.
Admon LK, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.37716.

Admon and colleagues conducted a cross-sectional study using deidentified data from a national sample of nearly 101,000 women who were commercially insured up to a year after giving birth from 2016 to 2017. The researchers analyzed rates of severe maternal morbidity with and without a blood transfusion during periods of hospitalization for birth, hospital discharge to 42 days postpartum, and 43 to 365 days postpartum. The mean age of the women was 31.6 years.

Lindsay K. Admon

Overall, rates of severe maternal morbidity with a transfusion were 177.7 (95% CI, 169.6-186) per 10,000 delivery hospitalizations during pregnancy, 61.1 (95% CI, 56.4-66.1) per 10,000 during early postpartum and 30.3 (95% CI, 27-33.9) per 10,000 during late postpartum. Moreover, rates of severe maternal morbidity without a transfusion were 105.2 (95% CI, 99-111.7), 56.5 (95% CI, 52-61.3) and 26.5 (95% CI, 23.5-29.9) per 10,000 delivery hospitalizations, respectively.

Compared with white women, Black women had higher rates of severe maternal morbidity with a transfusion for all periods. For example, during late postpartum, Black women had a rate of severe maternal morbidity of 44.3 (95% CI, 30-58.6) per 10,000 hospitalizations compared with 28.9 (95% CI, 24.7-33.2) per 10,000 hospitalizations among white women. Also, individuals with underlying perinatal mood and anxiety disorders experienced higher rates of severe maternal morbidity with a transfusion, according to the researchers.

“Clinicians should be aware of these risks and ask patients they encounter about having recently given birth,” Admon said. “We must recognize the particularly elevated risks for late postpartum health challenges among Black mothers and those struggling with perinatal depression and anxiety.”

Kara Zivin

Study coauthor Kara Zivin, PhD, MS, MA, MFA, a professor of psychiatry, obstetrics and gynecology and health management and policy at University of Michigan School of Public Health, stressed the importance of insurance coverage at least 1 year postpartum “to ensure access to care should unfortunate maternal morbidity conditions occur at any point during that period after delivery.”

References:

Admon LK, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.37716.

Maternal health risks linked to childbirth persist throughout postpartum year. https://labblog.uofmhealth.org/rounds/maternal-health-risks-linked-to-childbirth-persist-throughout-postpartum-year. Published Dec. 8, 2021. Accessed Dec. 8, 2021.