(494) Chronic conditions and risk for severe maternal morbidity stratified by maternal age ≥40

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: To assess trends in risk for non-transfusion severe maternal morbidity (ntSMM) stratified by maternal age and the presence or absence of chronic conditions.

Study Design: Birth hospitalizations were identified in the 2000-2019 National Inpatient Sample. Maternal age was dichotomized as 15-39 and 40-54 years of age. Conditions analyzed included chronic hypertension, substance use, pregestational diabetes, HIV, obesity and chronic respiratory, and heart, kidney and liver diseases. ntSMM was identified using CDC criteria. Trends in chronic conditions were stratified by age. Trends in ntSMM were stratified by age and chronic comorbidities. Trends were calculated using joinpoint regression with an annual average percent change (AAPC) estimated. Adjusted survey logistic regression models were fit stratified by age category with the primary predictor of chronic conditions and the outcome of ntSMM adjusting for demographic, hospital, and clinical factors. Results are reported as adjusted odds ratio (aOR) with 95% confidence intervals (CI).

Results: Of 76.7 million birth hospitalizations, 2.8% were to patients aged 40-54 years. 11.8% of deliveries had a chronic condition. Rates of chronic conditions increased significantly from 516 to 2,053 cases per 10,000 birth hospitalizations for 15-to-39-year-olds (AAPC 7.9%, 95% CI 7.6%, 8.3%) and from 922 to 2,561 cases (AAPC 6.0%, 95% CI 5.7%, 6.2%) for 40-to-54-year-olds (Figure 1). The ntSMM rates did not change significantly within age groups with and without chronic conditions (Figure 2). Adjusted analysis demonstrated increased odds for ntSMM among those 15–39 years of age (aOR 2.96, 95% CI 2.89, 3.03) and among those 40-54 years of age (aOR 2.32, 95% CI 2.18, 2.47).

Conclusion: Rates of ntSMM stratified by maternal age and the presence of chronic conditions were stable over the study period. However, the proportions of women aged 15-39 years and 40-54 years with chronic conditions increased continuously.

Primary & Presenting Author(s)

Jean Ju Sheen, MD
New York Presbyterian Hospital/Columbia University Medical Center
Northvale, New Jersey, United States

Coauthor(s)

Brittany Arditi, MD, MSCR
Resident Physician
Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
Alexander M. Friedman, MD
Columbia University Irving Medical Center
New York, New York, United States
Mary E. D'Alton, MD
Obstetrician and Gynecologist-in-Chief Willard C. Rappleye Professor and Chair
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center
New York, New York, United States
Timothy Wen, MD,MPH (he/him/his)
Clinical Fellow
University of California, San Francisco
San Francisco, California, United States