Evidence map›Paper›PMID 41286739›Full record

ArticleBMC pregnancy and childbirth2025

Association between preterm birth subtypes and severe maternal morbidity: a retrospective cohort study.

Tanko Rufai, Lucy T Greenberg, Scott A Lorch, Ciaran S Phibbs, Jeffrey S Buzas, Molly Passarella, George R Saade, Jeannette Rogowski, Nansi S Boghossian

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Article in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Tanko RufaiDepartment of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St. Rm 447, SC, 29208, Colombia.
Lucy T GreenbergVermont Oxford Network, Burlington, VT, USA.
Scott A LorchDepartment of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Ciaran S PhibbsHealth Economics Resource Center and Center for Implementation to Innovation, Veterans Affairs Palo Alto Health Care System, Menlo Park, CA, USA.
Jeffrey S BuzasDepartment of Mathematics and Statistics, University of Vermont, Burlington, VT, USA.
Molly PassarellaDepartment of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
George R SaadeDepartment of Obstetrics & Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA.
Jeannette RogowskiDepartment of Health Policy and Administration, The Pennsylvania State University, State College, Philadelphia, PA, USA.
Nansi S BoghossianDepartment of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene St. Rm 447, SC, 29208, Colombia. nboghoss@mailbox.sc.edu.

Funding

Hospital quality, Medicaid expansion, and racial/ethnic disparitiesin maternal mortality and morbidityR01MD016012 · NIMHD · UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA · PI BOGHOSSIAN, NANSI · 2020 to 2024
$3.2M
Institute for Child Health and Human Development R01HD084819 and R01HD099197NIMHD NIH HHS R01 MD016012NIMHD NIH HHS R01MD016012
6 · The paper itself

Abstract

backgroundSevere maternal morbidity (SMM) is a significant complication associated with preterm delivery. However, most studies have focused solely on SMM during the delivery hospitalization, without differentiating by preterm birth subtype or examining postpartum SMM and readmissions.

objectiveTo examine the association between preterm birth subtypes and SMM during delivery hospitalization, up to 1-year postpartum, and postpartum readmissions within 365 days. STUDY

designWe conducted a retrospective cohort study using linked birth and fetal death certificates and maternal hospital discharge data from Michigan, Oregon, and South Carolina (2008-2020). Modified Poisson regression models were used to estimate adjusted relative risks (aRR) and 95% confidence intervals (CI) for SMM during delivery hospitalization, postpartum SMM, and readmissions, stratified by preterm birth subtype. Models were adjusted for birth year, state, insurance type, education, maternal age, race/ethnicity, and adequacy of prenatal care.

resultsAmong 2,570,808 deliveries, 156,763 (6.1%) were spontaneous preterm births and 70,877 (2.8%) were medically indicated preterm births. For medically indicated preterm births, the aRR for SMM during delivery hospitalization were 18.0 (95% CI 16.7-19.4) at ≤ 31 weeks, 14.5 (95% CI 13.2-15.8) at 32-33 weeks, and 6.7 (95% CI 6.3-7.1) at 34-36 weeks. For spontaneous preterm births, the corresponding aRRs were 7.5 (95% CI 7.0-8.0), 6.4 (95% CI 5.9-7.0), and 3.1 (95% CI 2.9-3.3), respectively. During the postpartum period, elevated risks of SMM persisted for both subtypes. For medically indicated preterm births, aRRs for postpartum SMM ranged from 3.4 (95% CI 3.0-3.9) at ≤ 31 weeks to 2.1 (95% CI 2.0-2.3) at 34-36 weeks. For spontaneous preterm births, aRRs for postpartum SMM ranged from 2.0 (95% CI 1.8-2.2) at ≤ 31 weeks to 1.6 (95% CI 1.5-1.7) at 34-36 weeks. Postpartum readmission risk was also elevated for both subtypes.

conclusionPreterm delivery, particularly when medically indicated, is strongly associated with increased risk of SMM during delivery hospitalization, throughout the postpartum period, and with postpartum readmissions. These findings suggest that individuals experiencing preterm birth, especially medically indicated preterm deliveries, may benefit from targeted postpartum monitoring and follow-up, including earlier clinical contacts and closer surveillance for complications beyond the standard 6-week postpartum visit.

Indexed as

Premature BirthAdultFemaleHospitalizationHumansMichiganOregonPatient ReadmissionPostpartum PeriodPregnancyRetrospective StudiesRisk FactorsSouth CarolinaYoung AdultAcute renal failureAcute respiratory distress syndromeDisseminated intravascular coagulationHysterectomyMedically indicated pretermObstetric comorbidity index scorePostpartumSepsisSevere maternal morbiditySpontaneous preterm

Identifiers

PMID41286739
PMCPMC12642368

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.