title: Trends in maternal morbidity before and during pregnancy in California.
abstract: OBJECTIVE
  We examined trends in maternal comorbidities in California.
  
  
  METHODS
  We conducted a retrospective cohort study of 1,551,017 California births using state-linked vital statistics and hospital discharge cohort data for 1999, 2002, and 2005. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify the following conditions, some of which were preexisting: maternal hypertension, diabetes, asthma, thyroid disorders, obesity, mental health conditions, substance abuse, and tobacco use. We estimated prevalence rates with hierarchical logistic regression models, adjusting for demographic shifts, and also examined racial/ethnic disparities.
  
  
  RESULTS
  The prevalence of these comorbidities increased over time for hospital admissions associated with childbirth, suggesting that pregnant women are getting sicker. Racial/ethnic disparities were also significant. In 2005, maternal hypertension affected more than 10% of all births to non-Hispanic Black mothers; maternal diabetes affected nearly 10% of births to Asian/Pacific Islander mothers (10% and 43% increases, respectively, since 1999). Chronic hypertension, diabetes, obesity, mental health conditions, and tobacco use among Native American women showed the largest increases.
  
  
  CONCLUSIONS
  The prevalence of maternal comorbidities before and during pregnancy has risen substantially in California and demonstrates racial/ethnic disparity independent of demographic shifts.
authors.affiliation: Moshe Fridman is with AMF Consulting, Los Angeles, CA. Lisa M. Korst is with the Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, and Childbirth Research Associates, LLC, Los Angeles. Jessica Chow is with the Departments of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles (UCLA). Kimberly D. Gregory is with the Departments of Obstetrics and Gynecology, Cedars Sinai Medical Center and David Geffen School of Medicine, UCLA. Elizabeth Lawton is with the Maternal, Child and Adolescent Health Division, California Department of Public Health, Sacramento, under contract with the University of California San Francisco. Connie Mitchell is with the California Department of Public Health, Maternal, Child and Adolescent Health Division, Sacramento.
authors.forename: Moshe
authors.initials: M
authors.lastname: Fridman
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
authors.forename: Jessica
authors.initials: J
authors.lastname: Chow
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lawton
authors.forename: Connie
authors.initials: C
authors.lastname: Mitchell
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Gregory
mesh_terms: D000367:Age Factors; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D001523:Mental Disorders / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D015995:Prevalence; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012309:Risk-Taking; D012907:Smoking / Q000453:epidemiology