BJOG : an international journal of obstetrics and gynaecology · 2025
Long-Term Maternal Health Outcomes Following Severe Maternal Morbidity: A Cohort Study.
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Gothelf Itamar, Yoles Israel, Ben-Ayoun Danielle, Imterat Majdi, Walfisch Asnat, Wainstock Tamar
Аннотация
OBJECTIVE: To investigate the long-term morbidity experienced by women with a history of severe maternal morbidity (SMM).
DESIGN: Prospective population-based cohort study.
SETTING: A tertiary medical centre.
POPULATION: All women who experienced SMM between 2013 and 2018 and a matched comparison group without SMM.
METHODS: SMM was defined as maternal admission to the intensive care unit during the delivery hospitalisation. Women with SMM were matched 1:1 to controls based on mode and year of delivery. Multivariable Cox proportional hazards regression models were used to assess the adjusted risks of long-term diagnoses and hospitalisations, controlling for sociodemographic and clinical characteristics.
MAIN OUTCOME MEASURES: Long-term incidence of morbidities and hospitalisations.
RESULTS: A total of 288 women were included in the study, with a follow-up ranging from 6 to 11 years following the index pregnancy. Compared to women with no SMM in the index pregnancy, the SMM group demonstrated a significantly higher risk of cardiovascular and endocrine morbidities (adjusted HR: 4.01, 95% CI: 2.03-7.90 and 2.17; 95% CI: 1.24-3.79, respectively). Additionally, women with SMM in the index pregnancy had higher rates of SMM-related hospitalisations (adjusted HR: 1.90, 95% CI: 1.10-3.29), all-cause hospitalisations (adjusted HR: 2.21, 95% CI: 1.36-3.58) and hospitalisations within the first year following the index pregnancy (adjusted HR: 4.94, 95% CI: 1.06-23.13).
CONCLUSIONS: Women with SMM require vigilant multidisciplinary medical surveillance following discharge from their delivery hospitalisation. The occurrence of SMM may serve as a warning sign of significant long-term health risks.
DESIGN: Prospective population-based cohort study.
SETTING: A tertiary medical centre.
POPULATION: All women who experienced SMM between 2013 and 2018 and a matched comparison group without SMM.
METHODS: SMM was defined as maternal admission to the intensive care unit during the delivery hospitalisation. Women with SMM were matched 1:1 to controls based on mode and year of delivery. Multivariable Cox proportional hazards regression models were used to assess the adjusted risks of long-term diagnoses and hospitalisations, controlling for sociodemographic and clinical characteristics.
MAIN OUTCOME MEASURES: Long-term incidence of morbidities and hospitalisations.
RESULTS: A total of 288 women were included in the study, with a follow-up ranging from 6 to 11 years following the index pregnancy. Compared to women with no SMM in the index pregnancy, the SMM group demonstrated a significantly higher risk of cardiovascular and endocrine morbidities (adjusted HR: 4.01, 95% CI: 2.03-7.90 and 2.17; 95% CI: 1.24-3.79, respectively). Additionally, women with SMM in the index pregnancy had higher rates of SMM-related hospitalisations (adjusted HR: 1.90, 95% CI: 1.10-3.29), all-cause hospitalisations (adjusted HR: 2.21, 95% CI: 1.36-3.58) and hospitalisations within the first year following the index pregnancy (adjusted HR: 4.94, 95% CI: 1.06-23.13).
CONCLUSIONS: Women with SMM require vigilant multidisciplinary medical surveillance following discharge from their delivery hospitalisation. The occurrence of SMM may serve as a warning sign of significant long-term health risks.