Maternal morbidity and risk of death at delivery hospitalization.
OBJECTIVE
To examine the effect of underlying maternal morbidities on the odds of maternal death during delivery hospitalization.


METHODS
We used data that linked birth certificates to hospital discharge diagnoses from singleton live births at 22 weeks of gestation or later during 1995-2003 in New York City. Maternal morbidities examined included prepregnancy weight more than 114 kilograms (250 pounds), chronic hypertension, pregestational or gestational diabetes mellitus, chronic cardiovascular disease, pulmonary hypertension, chronic lung disease, human immunodeficiency virus (HIV), and preeclampsia or eclampsia. Associations with maternal mortality were estimated using multivariate logistic regression.


RESULTS
During the specified time period, 1,084,862 live singleton births and 132 maternal deaths occurred. Patients with increasing maternal age, non-Hispanic black ethnicity, self-pay or Medicaid, primary cesarean delivery, and premature delivery had higher rates of maternal mortality during delivery hospitalization. From the entire study population, 4.1% had preeclampsia or eclampsia (n=44,004), 1.8% had chronic hypertension (n=19,647), 1.1% of patients were classified as obese (n=11,936), 0.7% had pregestational diabetes (n=7,474), 0.4% had HIV (n=4,665), and 0.01% had pulmonary hypertension (n=166). Preeclampsia or eclampsia (adjusted odds ratio [OR], 8.1; 95% confidence interval [CI], 5.5-12.1), chronic hypertension (adjusted OR, 7.7; 95% CI 4.7-12.5), underlying maternal obesity (adjusted OR, 2.9; 95% CI 1.1-8.1), pregestational diabetes (adjusted OR, 3.3; 95% CI 1.3-8.1), HIV (adjusted OR, 7.7; 95% CI 3.4-17.8), and pulmonary hypertension (adjusted OR, 65.1; 95% CI 15.8-269.3) were associated with an increased risk of death during the delivery hospitalization.


CONCLUSIONS
The presence of maternal disease significantly increases the odds of maternal mortality at the time of delivery hospitalization.


METHODS
II.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Maternal-Fetal Medicine, Yale School of Medicine, New Haven, Connecticut, USA. katherine.campbell@yale.edu
Katherine H
KH
Campbell
David
D
Savitz
Erika F
EF
Werner
Christian M
CM
Pettker
Dena
D
Goffman
Cynthia
C
Chazotte
Heather S
HS
Lipkind
D000328:Adult; D036861:Delivery, Obstetric / Q000401:mortality; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008428:Maternal Mortality; D009518:New York / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D018570:Risk Assessment; D055815:Young Adult