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1 in 270 births have ‘dual burden’ of prematurity, severe maternal complications
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About one-quarter of mothers in California who experience severe maternal morbidity during childbirth, or SMM, also give birth prematurely, according to findings published in The Journal of Maternal-Fetal and Neonatal Medicine. Researchers suggested that as many as one in 270 births — or about 1,900 families — are affected by what they called the “dual burden” of preterm birth and SMM every year.
According to the CDC, SMM includes unexpected outcomes of labor and delivery that can create both short- and long-term health effects. The agency reports that rates of SMM have increased in the United States in recent years, but the reason is unclear.
Audrey Lyndon, PhD, RN, FAAN, a professor of nursing and assistant dean for clinical research at the New York University Rory Meyers College of Nursing, told Infectious Diseases in Children that the rate of dual burden in California likely reflects the rate observed in the U.S. However, she said that because California has a slightly lower prematurity rate than other states, the rate of dual burden could be higher in states where infants are more likely to be born early or where mothers are more likely to have serious complications.
“This is the first study of dual burden, so we cannot say specifically what the trend is,” Lyndon said. “Severe maternal morbidity has been increasing in the U.S., so it is possible that dual burden has increased as well.”
Lyndon and colleagues conducted a retrospective cohort study of more than 3 million live births occurring in California between 2007 and 2012. All infants were born between 20 and 44 weeks, and dual burden was defined as an infant being born before 37 weeks’ gestational age, combined with SMM.
According to the researchers, the rate of preterm birth was 876 per 10,000 births, and the rate of SMM was 140 per 10,000 births. One in four women with SMM experienced preterm birth, with a dual burden rate of 37 per 10,000 births. Mothers with SMM were most likely to have blood transfusions with several cardiac indications.
The dual burden rate was three times higher among mothers requiring cesarean section (primiparous primary adjusted RR = 3.3; 95% CI, 3-3.6) and six times higher among women having more than one child (aRR = 6.3; 95% CI, 5.8-6.9). Additionally, the researchers said there was an increased risk for dual burden among women with preeclampsia superimposed on gestational hypertension (aRR = 7.3; 95% CI, 6.8-7.9) and pre-existing hypertension without preeclampsia (aRR = 11.1; 95% CI, 9.9-12.5).
Lyndon and colleagues highlighted several risk factors for dual burden, including smoking during pregnancy (aRR = 1.5; 95% CI, 1.4-1.7), pre-existing hypertension (aRR = 2.6; 95% CI, 2.3-3), black race and/or ethnicity (aRR = 2; 95% CI, 1.8-2.2) and a BMI more than 18.5 before pregnancy (aRR = 1.4; 95% CI, 1.3-1.5).
To ensure that mothers and their infants have the best possible outcomes, Lyndon said clinicians should provide “respectful, person- and family-centered care at all times.”
“Listen to mothers,” she said. “They are experts on their own bodies, and their concerns should be taken seriously. Clinicians can also implement patient safety bundles, work to build programs that bridge the birthing unit with the NICU to coordinate care for families with both maternal and infant needs, and ensure good follow-up for women with high blood pressure and families that have experienced dual burden.”
In addition, Lyndon suggested that institutions that do not have a family advisory council should build one that “engages the community in understanding and meeting community needs to improve care.”
Finally, clinicians can “learn about the role of racism and discrimination in shaping health outcomes and work to break that down within their particular settings,” she said. – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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