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Evaluating Iowa Severe Maternal Morbidity Trends and Maternal Risk Factors: 2009–2014

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Abstract

Objectives To describe statewide SMM trends in Iowa from 2009 to 2014 and identify maternal characteristics associated with SMM, overall and by age group. Methods We used 2009–2014 linked Iowa birth certificate and hospital discharge data to calculate SMM based on a 25-condition definition and 24-condition definition. The 24-condition definition parallels the 25-condition definition, but excludes blood transfusions. We calculated SMM rates for all delivery hospitalizations (N = 196,788) using ICD-9-CM diagnosis and procedure codes. We used log-binomial regression to assess the association of SMM with maternal characteristics, overall and stratified by age groupings. Results In contrast to national rates, Iowa’s 25-condition SMM rate decreased from 2009 to 2014. Based on the 25-condition definition, SMM rates were significantly higher among women <20 years and >34 years compared to women 25–34 years. Blood transfusion was the most prevalent indicator, with hysterectomy and disseminated intravascular coagulation (DIC) among the top five conditions. Based on the 24-condition definition, younger women had the lowest SMM rates and older women had the highest SMM rates. SMM rates were also significantly higher among racial/ethnic minorities compared to non-Hispanic white women. Payer was the only risk factor differentially associated with SMM across age groups. First trimester prenatal care initiation was protective for SMM in all models. Conclusions High rates of blood transfusion, hysterectomy, and DIC indicate a need to focus on reducing hemorrhage in Iowa. Both younger and older women and racial/ethnic minorities are identified as high risk groups for SMM that may benefit from special consideration and focus.

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Notes

  1. Hospital levels of care in Iowa are based on a combination of maternal and newborn perinatal care needs and risk factors.

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Acknowledgements

This study was supported in part by an appointment to the Applied Epidemiology Fellowship Program administered by the Council of State and Territorial Epidemiologists (CSTE) and funded by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement Number 1U380T000143-02.

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Authors and Affiliations

  1. Iowa Department of Public Health, Bureau of Family Health, Des Moines, IA, USA

    Brittni N. Frederiksen & Debra J. Kane

  2. CDC/CSTE Applied Epidemiology Fellowship, Atlanta, GA, USA

    Brittni N. Frederiksen

  3. Iowa Department of Public Health, Bureau of Nutrition and Health Promotion, Des Moines, IA, USA

    Catherine J. Lillehoj

  4. CDC/Division of Reproductive Health/Field Support Branch, Atlanta, GA, USA

    Debra J. Kane

  5. CDC/Division of Reproductive Health, Atlanta, GA, USA

    Dave Goodman

  6. Divison of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA

    Kristin Rankin

  7. U.S. Office of Population Affairs, 1101 Wootton Parkway, Suite 700, Rockville, MD, 20852, USA

    Brittni N. Frederiksen

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  1. Brittni N. Frederiksen
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  2. Catherine J. Lillehoj
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  3. Debra J. Kane
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Correspondence to Brittni N. Frederiksen.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Additional information

Source: Iowa Hospital Discharge Data 2009–2014 and Iowa Birth Certificate Data 2009–2014.

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Frederiksen, B.N., Lillehoj, C.J., Kane, D.J. et al. Evaluating Iowa Severe Maternal Morbidity Trends and Maternal Risk Factors: 2009–2014. Matern Child Health J 21, 1834–1844 (2017). https://doi.org/10.1007/s10995-017-2301-4

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  • DOI: https://doi.org/10.1007/s10995-017-2301-4

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