title: Risk factors for maternal morbidity in Victoria, Australia: a population-based study.
abstract: OBJECTIVE
  The aim of this analysis was to quantify the risk factors associated with maternal morbidity among women in Victoria, Australia, focusing particularly on sociodemographic factors.
  
  
  METHODS
  Case-control analysis.
  
  
  METHODS
  Data on all maternities in Victoria from 1 January 2006 to 31 December 2008.
  
  
  METHODS
  A case-control analysis was conducted using unconditional logistic regression to calculate adjusted ORs (aORs). Cases were defined as all women noted to have had a severe complication during the index pregnancy. Severe maternal morbidity was defined by the validated, composite Australian Maternal Morbidity Outcome Indicator. Socioeconomic position was defined by Socio-Economic Indices for Areas (SEIFA), specifically the Index of Relative Socioeconomic Disadvantage (IRSD), and other variables analysed were age, parity, Indigenous background, multiple pregnancy, country of birth, coexisting medical condition, previous caesarean section, spontaneous abortion or ectopic pregnancy.
  
  
  RESULTS
  The study population comprised 211,060 women, including 1119 cases of severe maternal morbidity (0.53%). Compared with the highest IRSD quintile, the aOR for the 2nd quintile was 1.23 (95% CI 1.03 to 1.49), 0.98 (95% CI 0.79 to 1.21) for the 3rd quintile, 1.55 (95% CI 1.28 to 1.87) for the 4th and 1.21 (95% CI 1.00 to 1.47) for the lowest (most deprived) quintile. Indigenous status was associated with twice (aOR 2.02; 95% CI 1.32 to 3.09) the odds of being a case. Other risk factors for severe maternal morbidity were age ≥ 35 years (aOR 1.22; 95% CI 1.04 to 1.44), coexisting medical condition (aOR 1.39; 95% CI 1.16 to 1.65), multiple pregnancy (aOR 2.30; 95% CI 1.71 to 3.10), primiparity (aOR 1.36; 95% CI 1.18 to 1.57), previous caesarean section (aOR 1.79; 95% CI 1.53 to 2.10) and previous spontaneous miscarriage (aOR 1.25; 95% CI 1.08 to 1.44).
  
  
  CONCLUSIONS
  The findings from Victoria strongly suggest that social disadvantage needs to be acknowledged and further investigated as an independent risk factor for adverse maternal outcomes in Australia and incorporated into appropriate policy planning and healthcare programmes.
authors: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
authors: Anthea C
authors: AC
authors: Lindquist
authors: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
authors: Jennifer J
authors: JJ
authors: Kurinczuk
authors: Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia The Ritchie Centre, MIMR-PHI Institute of Medical Research, Clayton, Victoria, Australia.
authors: Euan M
authors: EM
authors: Wallace
authors: Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
authors: Jeremy
authors: J
authors: Oats
authors: National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
authors: Marian
authors: M
authors: Knight
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section; D015897:Comorbidity; D005260:Female; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D010298:Parity; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011272:Pregnancy, Multiple; D012307:Risk Factors; D012959:Socioeconomic Factors; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: EPIDEMIOLOGY; OBSTETRICS; PUBLIC HEALTH