Carla L DeSisto, Alexander C Ewing, Hafsatou Diop, Sarah Rae Easter, Elizabeth Harvey, Debra J Kane, Miriam Naiman-Sessions, Godwin Osei-Poku, Melanie Riley, Birgit Shanholtzer, Audrey M Stach, Ramya Dronamraju, Andrea Catalano, Elizabeth A Clark, Sabrina A Madni, Lindsay S Womack, Elena V Kuklina, David A Goodman, Sarah J Kilpatrick, M Kathryn Menard
{"title":"Maternal Risk Conditions and Outcomes by Levels of Maternal Care.","authors":"Carla L DeSisto, Alexander C Ewing, Hafsatou Diop, Sarah Rae Easter, Elizabeth Harvey, Debra J Kane, Miriam Naiman-Sessions, Godwin Osei-Poku, Melanie Riley, Birgit Shanholtzer, Audrey M Stach, Ramya Dronamraju, Andrea Catalano, Elizabeth A Clark, Sabrina A Madni, Lindsay S Womack, Elena V Kuklina, David A Goodman, Sarah J Kilpatrick, M Kathryn Menard","doi":"10.1089/jwh.2024.0547","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Objectives:</i></b> To (1) determine associations between maternal risk conditions and severe adverse outcomes that may benefit from risk-appropriate care and (2) assess whether associations between risk conditions and outcomes vary by level of maternal care (LoMC). <b><i>Methods:</i></b> We used the 2017-2019 National Inpatient Sample (NIS) to calculate associations between maternal risk conditions and severe adverse outcomes. Risk conditions included severe preeclampsia, placenta accreta spectrum (PAS) conditions, and cardiac conditions. Outcomes included disseminated intravascular coagulation (DIC) with blood products transfusion or shock, pulmonary edema or acute respiratory distress syndrome (ARDS), stroke, acute renal failure, and a composite cardiac outcome. Then we used 2019 delivery hospitalization data from five states linked to hospital LoMC. We calculated associations between risk conditions and outcomes overall and stratified by LoMC and assessed for effect modification by LoMC. <b><i>Results:</i></b> We found positive measures of association between risk conditions and outcomes. Among patients with severe preeclampsia or PAS, the magnitudes of the associations with DIC with blood products transfusion or shock, pulmonary edema or ARDS, and acute renal failure were lower in Level III/IV compared with <Level III facilities. Among patients with cardiac conditions, the magnitudes of the associations with these outcomes, along with stroke, were also lower in Level III/IV compared with <Level III facilities. The proportion of patients with risk conditions that delivered in <Level III facilities was 19.8-46.8%. <b><i>Conclusions:</i></b> Odds of severe adverse outcomes among women with selected risk conditions were lower for births occurring at higher-level facilities, supporting the benefit of risk-appropriate care.</p>","PeriodicalId":17636,"journal":{"name":"Journal of women's health","volume":" ","pages":""},"PeriodicalIF":3.0000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of women's health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1089/jwh.2024.0547","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives: To (1) determine associations between maternal risk conditions and severe adverse outcomes that may benefit from risk-appropriate care and (2) assess whether associations between risk conditions and outcomes vary by level of maternal care (LoMC). Methods: We used the 2017-2019 National Inpatient Sample (NIS) to calculate associations between maternal risk conditions and severe adverse outcomes. Risk conditions included severe preeclampsia, placenta accreta spectrum (PAS) conditions, and cardiac conditions. Outcomes included disseminated intravascular coagulation (DIC) with blood products transfusion or shock, pulmonary edema or acute respiratory distress syndrome (ARDS), stroke, acute renal failure, and a composite cardiac outcome. Then we used 2019 delivery hospitalization data from five states linked to hospital LoMC. We calculated associations between risk conditions and outcomes overall and stratified by LoMC and assessed for effect modification by LoMC. Results: We found positive measures of association between risk conditions and outcomes. Among patients with severe preeclampsia or PAS, the magnitudes of the associations with DIC with blood products transfusion or shock, pulmonary edema or ARDS, and acute renal failure were lower in Level III/IV compared with Conclusions: Odds of severe adverse outcomes among women with selected risk conditions were lower for births occurring at higher-level facilities, supporting the benefit of risk-appropriate care.
期刊介绍:
Journal of Women''s Health is the primary source of information for meeting the challenges of providing optimal health care for women throughout their lifespan. The Journal delivers cutting-edge advancements in diagnostic procedures, therapeutic protocols for the management of diseases, and innovative research in gender-based biology that impacts patient care and treatment.
Journal of Women’s Health coverage includes:
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Endocrinology-
Cardiology-
Oncology-
Obstetrics/Gynecology-
Urogynecology-
Psychiatry-
Neurology-
Nutrition-
Sex-Based Biology-
Complementary Medicine-
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Medical Education-
Public Policy.