(837) Uterine fibroids and severe maternal morbidity

We sought to identify the relationship between uterine fibroids and severe maternal morbidity (SMM) as well as other pregnancy complications in a large national cohort.

Study Design:

This was a retrospective cohort study of pregnant patients from the National Inpatient Sample database (HCUP) from 2017-2019. Subjects were separated into two groups based on a diagnosis of fibroids from hospital ICD-10 coding. The primary outcome was the rate of SMM, as defined by the Centers for Disease Control (CDC). Secondary outcomes included SMM excluding transfusion, as well as other pregnancy complications and need for additional surgical intervention. Student’s t-tests, chi-squared and logistic regression were used for analysis with p< 0.05 for statistical significance.

Results:

A total of 2,287,001 subjects were included with 33,836 (1.5%) diagnosed with fibroids. Patients with fibroids were more likely to be older, non-Hispanic black, privately insured, and in the upper income quartile (p< 0.001). They were also more likely to have comorbid diabetes, chronic hypertension, anemia, and history of c-section (p< 0.001). Rates of SMM were significantly higher in those with fibroids compared to those without (5.7% vs 3.2%, p< 0.001). Incidence of SMM excluding transfusion was also more common (3.3% vs 2.2%, p< 0.001), as were other complications including hemorrhage, transfusion, disseminated intravascular coagulation, hysterectomy, urinary or abdominal organ injury, ileus or small bowel obstruction, and need for IR embolization (all p< 0.001). Maternal death was similar across both groups (p=0.704). After controlling for confounders, SMM remained independently associated with maternal fibroids (aOR 1.54, 95%CI 1.47-1.62), as did SMM excluding transfusion, and other secondary outcomes listed in the table.

Conclusion:

Uterine fibroids are associated with higher rates of SMM as defined by the CDC and other significant complications of pregnancy.