title: Effects of medical co-morbidities on severe maternal morbidities in China: a multicenter clinic register study.
abstract: OBJECTIVE
  To investigate the incidence of severe maternal morbidities (SMM) in China and explore effects of medical co-morbidities on SMM.
  
  
  METHODS
  Proactive multicenter clinic register collaboration.
  
  
  METHODS
  Data on all deliveries at eight hospitals in Sichuan province, China, collected from 1 January 2009 to 12 December 2010.
  
  
  METHODS
  33 993 delivering women and 34 547 live births.
  
  
  METHODS
  We defined SMM as a combination indicator of severe maternal complications, critical interventions, admission to the intensive care unit and maternal near-miss instances. We randomly selected 80% of the data from the entire database to build a logistic regression model. The remaining 20% were used to test the predictive power of the model.
  
  
  METHODS
  SMM incidence, adjusted odds ratios (aORs), and area under a receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  Severe maternal morbidities incidence was 43.4/1000 live births [confidence interval (CI) 41.24-45.56]. Fifteen variables were independent contributors to the model. Seven medical co-morbidities significantly affected the occurrence of SMM, including iron-deficiency anemia (aOR 3.07, CI 2.47-3.83) and other hematological diseases (aOR 5.82, CI 3.50-9.69), hepatitis-B virus infection (aOR 1.48, CI 1.12-1.97) and other hepatic diseases (aOR 3.81, CI 1.61-9.04), cardiopathy (aOR 3.59, CI 2.62-4.93), hypertension (aOR 5.23, CI 4.06-6.75), and respiratory diseases (aOR 2.10, CI 1.25-3.52). The area under the ROC curve was 0.8127.
  
  
  CONCLUSIONS
  The incidence of SMM was typical of a low resource area. There is a need to identify medical co-morbidities and to adopt prophylactic measures and interventions.
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.|Chengdu University of Traditional Chinese Medicine, Chengdu, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Tan
authors.affiliation: West China Women's and Children's Hospital, Sichuan University, Chengdu, China.
authors.forename: Xing-Hui
authors.initials: XH
authors.lastname: Liu
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Chuan
authors.initials: C
authors.lastname: Yu
authors.affiliation: West China Women's and Children's Hospital, Sichuan University, Chengdu, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Chen
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xiao-Fan
authors.initials: XF
authors.lastname: Chen
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Sun
authors.affiliation: Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: You-Ping
authors.initials: YP
authors.lastname: Li
mesh_terms: D000328:Adult; D000367:Age Factors; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012372:ROC Curve; D012042:Registries; D012307:Risk Factors; D055815:Young Adult
keywords: China; Severe maternal morbidities; logistic regression model; medical co-morbidities; multicenter clinic register study