The Extent of Maternal Morbidity in a Managed Care Setting

Although 6 million women become pregnant each year, little is known about the extent of antepartum, intrapartum, and postpartum morbidity. Previous studies have been limited to measuring hospitalizations as a proxy for complications for individual women. These data do not account for multiple hospitalizations per woman, nor do they consider morbidity occurring during the delivery hospitalization or postpartum. Further, because of changes in the health care system and trends in the management of many conditions, treatment of pregnancy-related complications in an outpatient setting is increasing. Current data do not permit accurate measurement of the incidence and prevalence of the full spectrum of maternal morbidity.

In 1992, National Hospital Discharge Survey (NHDS) data for 1986 and 1987 indicated that 22.2 antenatal hospitalizations occurred per 100 deliveries. This estimate was updated in 1998 using 1991 and 1992 NHDS data and the ratio was 16.7 hospitalizations per 100 deliveries. The most recent estimate for 1999–2000 is 12.8 hospitalizations per 100 deliveries. In spite of the trend of decreasing hospitalizations during pregnancy prior to delivery, there is little evidence to suggest that overall maternal morbidity is decreasing. None of these estimates take into account women with complications who were not hospitalized or women with postpartum complications; therefore, they underestimate the true magnitude of maternal morbidity. Potential reductions in maternal morbidity depend on a greater understanding of their etiologies and patterns.

Scientists in DRH are collaborating with researchers in a large managed care organization to conduct a comprehensive examination of complications related to pregnancy. The data will provide a considerable advance in information needed to study causes of pregnancy complications, detect differences in complications over time, and evaluate effects of changes in care practices. The prevalence of antepartum, intrapartum, and postpartum morbidities among women in this health care system will be determined. In the future, the methodology developed in this study can be applied to an expanded database and in-depth studies of maternal morbidity may be possible. In addition, these methods can be used to establish ongoing surveillance of maternal morbidities, enabling early detection of sentinel events among pregnant women and identification of trends in morbidities related to behavioral and environmental risks.

Division of Reproductive Health's Maternal Health, Infant Health, and Preterm Delivery
In the United States each year, approximately six million women become pregnant. While most women have a normal term pregnancy and deliver a normal infant, a safe and healthy pregnancy is not the experience of all women ...more

Date last reviewed: 05/19/2006
Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion