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• W2990779892 abstract "BackgroundSevere maternal morbidity is an important proxy for maternal mortality. The population-attributable fraction is the proportion of a disease that is attributable to a given risk factor and can be used to estimate the reduction in the disease that would be anticipated if a risk factor were reduced or eliminated.ObjectiveWe sought to determine the population-attributable fraction of potentially modifiable risk factors for severe maternal morbidity.Materials and MethodsWe used a retrospective cohort of 86,260 delivery hospitalizations from Magee-Womens Hospital, Pittsburgh, PA, for this analysis (2003−2012). Severe maternal morbidity was defined as any of the following: Centers for Disease Control and Prevention International Classification of Diseases 9th Revision diagnosis and procedure codes for the identification of maternal morbidity; prolonged postpartum length of stay (defined as >3 standard deviations beyond the mean length of stay: >3 days for vaginal deliveries and >5 days for cesarean deliveries); or maternal intensive care unit admission. We used multivariable logistic regression with generalized estimating equations to estimate the association of prepregnancy overweight or obesity, maternal age ≥35 years, preexisting hypertension, preexisting diabetes, excessive gestational weight gain, smoking, education, and marital status with severe maternal morbidity. We then calculated the population-attributable fraction for each risk factor. We also examined the impact of modest reductions and elimination of risk factors on the population-attributable fraction of severe maternal morbidity.ResultsThe overall rate of severe maternal morbidity was 2.0%. Overweight and obesity, maternal age ≥35 years, preexisting hypertension, excessive gestational weight gain, and lack of a college degree had population-attributable fractions ranging from 4.5% to 13%. If all risk factors had been eliminated, 36% of cases could have been prevented. Modest reductions in the prevalence of excessive body mass index and advanced maternal age had minimal impact on preventing severe maternal morbidity. Smoking during pregnancy and marital status were not associated with severe maternal morbidity.ConclusionOur data suggest that maternal morbidity can be reduced by modifying common, individual-level risk factors. Nevertheless, the majority of cases were not attributable to the patient-level risk factors that we examined. These data support the need for large studies of patient-, provider-, system-, and population-level factors to identify high-impact interventions to reduce maternal morbidity. Severe maternal morbidity is an important proxy for maternal mortality. The population-attributable fraction is the proportion of a disease that is attributable to a given risk factor and can be used to estimate the reduction in the disease that would be anticipated if a risk factor were reduced or eliminated. We sought to determine the population-attributable fraction of potentially modifiable risk factors for severe maternal morbidity. We used a retrospective cohort of 86,260 delivery hospitalizations from Magee-Womens Hospital, Pittsburgh, PA, for this analysis (2003−2012). Severe maternal morbidity was defined as any of the following: Centers for Disease Control and Prevention International Classification of Diseases 9th Revision diagnosis and procedure codes for the identification of maternal morbidity; prolonged postpartum length of stay (defined as >3 standard deviations beyond the mean length of stay: >3 days for vaginal deliveries and >5 days for cesarean deliveries); or maternal intensive care unit admission. We used multivariable logistic regression with generalized estimating equations to estimate the association of prepregnancy overweight or obesity, maternal age ≥35 years, preexisting hypertension, preexisting diabetes, excessive gestational weight gain, smoking, education, and marital status with severe maternal morbidity. We then calculated the population-attributable fraction for each risk factor. We also examined the impact of modest reductions and elimination of risk factors on the population-attributable fraction of severe maternal morbidity. The overall rate of severe maternal morbidity was 2.0%. Overweight and obesity, maternal age ≥35 years, preexisting hypertension, excessive gestational weight gain, and lack of a college degree had population-attributable fractions ranging from 4.5% to 13%. If all risk factors had been eliminated, 36% of cases could have been prevented. Modest reductions in the prevalence of excessive body mass index and advanced maternal age had minimal impact on preventing severe maternal morbidity. Smoking during pregnancy and marital status were not associated with severe maternal morbidity. Our data suggest that maternal morbidity can be reduced by modifying common, individual-level risk factors. Nevertheless, the majority of cases were not attributable to the patient-level risk factors that we examined. These data support the need for large studies of patient-, provider-, system-, and population-level factors to identify high-impact interventions to reduce maternal morbidity." @default.
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• W2990779892 date "2020-02-01" @default.
• W2990779892 modified "2023-10-15" @default.
• W2990779892 title "Population-attributable fraction of risk factors for severe maternal morbidity" @default.
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• W2990779892 doi "https://doi.org/10.1016/j.ajogmf.2019.100066" @default.
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