Severe Maternal Morbidity in Georgia, 2009-2020

• Type of Material: Article
• Authors: Michael Kramer, Emory University; Katie Labgold, North Carolina State University; Adrienne D Zertuche, Piedmont Womens Healthcare; Jennifer D Runkle, North Carolina State University; Michael Bryan, Georgia Department of Public Health; Gordon R Freymann, Georgia Department of Public Health; David Austin, Georgia Department of Public Health; Kathleen E Adams, Emory University; Anne Dunlop, Emory University
• Language: English
• Date: 2023-05-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/MLR.0000000000001819
• Title of Journal or Parent Work: MEDICAL CARE
• Volume: 61
• Issue: 5
• Start Page: 258
• End Page: 267
• Grant/Funding Information: This project was supported in part by the American College of Obstetrics and Gynecology/Warren H. Pearse Women’s Health Policy Research Award (Dr. Zertuche); by the Health Resources and Service Administration (HRSA) Maternal and Child Health Bureau grant T76MC28446 to the Emory Maternal and Child Health Center of Excellence; and by National Institute of Health/National Institute on Minority Health and Health Disparities R01MD016031.
• Keywords: DELIVERY; MORTALITY; WOMEN; MEDICAID EXPANSION; Life Sciences & Biomedicine; Health Policy & Services; Science & Technology; retrospective birth cohort; HOSPITALIZATIONS; severe maternal morbidity; surveillance; maternal health; Public, Environmental & Occupational Health; Health Care Sciences & Services
• Research Categories: Health Sciences, Epidemiology

Abstract

Background: The increasing focus of population surveillance and research on maternal - and not only fetal and infant - health outcomes is long overdue. The United States maternal mortality rate is higher than any other high-income country, and Georgia is among the highest rates in the country. Severe maternal morbidity (SMM) is conceived of as a "near miss"for maternal mortality, is 50 times more common than maternal death, and efforts to systematically monitor SMM rates in populations have increased in recent years. Much of the current population-based research on SMM has occurred in coastal states or large cities, despite substantial geographical variation with higher maternal and infant health burdens in the Southeast and rural regions. Methods: This population-based study uses hospital discharge records linked to vital statistics to describe the epidemiology of SMM in Georgia between 2009 and 2020. Results: Georgia had a higher SMM rate than the United States overall (189.2 vs. 144 per 10,000 deliveries in Georgia in 2014, the most recent year with US estimates). SMM was higher among racially minoritized pregnant persons and those at the extremes of age, of lower socioeconomic status, and with comorbid chronic conditions. SMM rates were 5 to 6 times greater for pregnant people delivering infants <1500 grams or <32 weeks' gestation as compared with those delivering normal weight or term infants. Since 2015, SMM has increased in Georgia. Conclusion: SMM represents a collection of life-threatening emergencies that are unevenly distributed in the population and require increased attention. This descriptive analysis provides initial guidance for programmatic interventions intending to reduce the burden of SMM and, subsequently, maternal mortality in the US South.