ArticleJournal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC2026
Intersectional Disparities in Severe Maternal Morbidity Across the Perinatal Continuum: A Population-Based Analysis.
Article in Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2026. 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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Abstract
objectivesThis study aimed to estimate the risk of severe maternal morbidity (SMM) by race/ethnicity and physical disability status across the perinatal continuum using an intersectional framework.
methodsWe conducted a retrospective cohort study of 1 327 862 singleton births in Massachusetts (1999-2019) using the Pregnancy to Early Life Longitudinal Data System. SMM was identified using the 20 indicators defined by the Centers for Disease Control and Prevention, with a secondary analysis including transfusion. We examined 3 mutually exclusive time periods: prenatal (non-delivery prenatal hospitalizations), delivery, and postpartum (≤365 days after delivery discharge). Modified Poisson regression models estimated unadjusted and adjusted relative risks of SMM by race/ethnicity and physical disability status, with non-disabled White birthing persons serving as the reference. Additive interaction was assessed using the relative excess risk due to interaction and the attributable proportion.
resultsSMM rates were 10.1 per 10 000 prenatal hospitalizations, 43.2 per 10 000 delivery hospitalizations, and 14.3 per 10 000 postpartum hospitalizations. Compared with non-disabled White birthing persons, Black and Hispanic birthing persons with physical disabilities had the highest adjusted risks across all periods: prenatal (adjusted relative risk [aRR] 9.93, 95% confidence interval [CI] 7.32-13.47; aRR 5.67, 95% CI 4.18-7.69; respectively), delivery (aRR 4.65, 95% CI 3.73-5.81; aRR 3.14, 95% CI 2.51-3.93), and postpartum (aRR 4.86, 95% CI 3.44-6.85; aRR 3.50, 95% CI 2.56-4.76). Values of relative excess risk due to interaction indicated significant super-additive interaction, suggesting compounded effects of race/ethnicity and disability.
conclusionsThis population-based study provides evidence that multiply marginalized birthing persons experience compounded health disparities that persist even after adjusting for sociodemographic and clinical factors. Efforts are needed to ensure that persons with multiple marginalized identities have access to comprehensive, accessible, disability-competent, and culturally sensitive maternal and perinatal health care services.
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