{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T05:18:34Z","timestamp":1793164714962,"version":"4.5.0"},"reference-count":71,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The rate of severe maternal morbidity (SMM) is continuously increasing in the US. Evidence regarding the associations of climate-related exposure, such as environmental heat, with SMM is lacking.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine associations between long- and short-term maternal heat exposure and SMM.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective population-based epidemiological cohort study took place at a large integrated health care organization, Kaiser Permanente Southern California, between January 1, 2008, and December 31, 2018. Data were analyzed from February to April 2023. Singleton pregnancies with data on SMM diagnosis status were included.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Moderate, high, and extreme heat days, defined as daily maximum temperatures exceeding the 75th, 90th, and 95th percentiles of the time series data from May through September 2007 to 2018 in Southern California, respectively. Long-term exposures were measured by the proportions of different heat days during pregnancy and by trimester. Short-term exposures were represented by binary variables of heatwaves with 9 different definitions (combining percentile thresholds with 3 durations; ie, \u22652, \u22653, and \u22654 consecutive days) during the last gestational week.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was SMM during delivery hospitalization, measured by 20 subconditions excluding blood transfusion. Discrete-time logistic regression was used to estimate associations with long- and short-term heat exposure. Effect modification by maternal characteristics and green space exposure was examined using interaction terms.<\/jats:p><\/jats:sec>Results<\/jats:title>There were 3446 SMM cases (0.9%) among 403\u202f602 pregnancies (mean [SD] age, 30.3 [5.7] years). Significant associations were observed with long-term heat exposure during pregnancy and during the third trimester. High exposure (\u226580th percentile of the proportions) to extreme heat days during pregnancy and during the third trimester were associated with a 27% (95% CI, 17%-37%; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and 28% (95% CI, 17%-41%; P<\/jats:italic>\u2009&amp;lt;\u2009.001) increase in risk of SMM, respectively. Elevated SMM risks were significantly associated with short-term heatwave exposure under all heatwave definitions. The magnitude of associations generally increased from the least severe (HWD1: daily maximum temperature &amp;gt;75th percentile lasting for \u22652 days; odds ratio [OR], 1.32; 95% CI, 1.17-1.48; P<\/jats:italic>\u2009&amp;lt;\u2009.001) to the most severe heatwave exposure (HWD9: daily maximum temperature &amp;gt;95th percentile lasting for \u22654 days; OR, 2.39; 95% CI, 1.62-3.54; P<\/jats:italic>\u2009&amp;lt;\u2009.001). Greater associations were observed among mothers with lower educational attainment (OR for high exposure to extreme heat days during pregnancy, 1.43; 95% CI, 1.26-1.63; P<\/jats:italic>\u2009&amp;lt;\u2009.001) or whose pregnancies started in the cold season (November through April; OR, 1.37; 95% CI, 1.24-1.53; P<\/jats:italic>\u2009&amp;lt;\u2009.001).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this retrospective cohort study, long- and short-term heat exposure during pregnancy was associated with higher risk of SMM. These results might have important implications for SMM prevention, particularly in a changing climate.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.32780","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T15:33:04Z","timestamp":1694100784000},"page":"e2332780","source":"Crossref","is-referenced-by-count":59,"title":["Analysis of Heat Exposure During Pregnancy and Severe Maternal Morbidity"],"prefix":"10.1001","volume":"6","author":[{"given":"Anqi","family":"Jiao","sequence":"first","affiliation":[{"name":"Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine"},{"name":"Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Avila","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Slezak","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Sacks","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena"},{"name":"Department of Obstetrics and Gynecology, University of Southern California, Keck School of Medicine, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Abatzoglou","sequence":"additional","affiliation":[{"name":"School of Engineering, University of California, Merced"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Molitor","sequence":"additional","affiliation":[{"name":"College of Public Health and Human Sciences, Oregon State University, Corvallis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiu-Chiuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarik","family":"Benmarhnia","sequence":"additional","affiliation":[{"name":"Scripps Institution of Oceanography, University of California, San Diego"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darios","family":"Getahun","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena"},{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,9,7]]},"reference":[{"issue":"3","key":"zoi230947r2","doi-asserted-by":"publisher","first-page":"B17","DOI":"10.1016\/j.ajog.2016.07.050","article-title":"Severe maternal morbidity: screening and review.","volume":"215","author":"Kilpatrick","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"6","key":"zoi230947r3","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1053\/j.semperi.2017.07.007","article-title":"Epidemiology of maternal morbidity and mortality.","volume":"41","author":"Hirshberg","year":"2017","journal-title":"Semin Perinatol"},{"issue":"3","key":"zoi230947r4","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1053\/j.semperi.2017.03.005","article-title":"Maternal early warning systems\u2014towards reducing preventable maternal mortality and severe maternal morbidity through improved clinical surveillance and responsiveness.","volume":"41","author":"Zuckerwise","year":"2017","journal-title":"Semin Perinatol"},{"issue":"5","key":"zoi230947r5","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1097\/AOG.0b013e31826d60c5","article-title":"Severe maternal morbidity among delivery and postpartum hospitalizations in the United States.","volume":"120","author":"Callaghan","year":"2012","journal-title":"Obstet Gynecol"},{"issue":"9726","key":"zoi230947r6","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1016\/S0140-6736(10)60518-1","article-title":"Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5.","volume":"375","author":"Hogan","year":"2010","journal-title":"Lancet"},{"key":"zoi230947r7","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1186\/s12978-018-0527-2","article-title":"A global view of severe maternal morbidity: moving beyond maternal mortality.","volume":"15","author":"Geller","year":"2018","journal-title":"Reprod Health"},{"issue":"2","key":"zoi230947r9","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1097\/GRF.0000000000000370","article-title":"Reducing maternal mortality and severe maternal morbidity: the role of critical care.","volume":"61","author":"Shamshirsaz","year":"2018","journal-title":"Clin Obstet Gynecol"},{"issue":"1","key":"zoi230947r10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1089\/jwh.2013.4617","article-title":"Maternal mortality and morbidity in the United States: where are we now?","volume":"23","author":"Creanga","year":"2014","journal-title":"J Womens Health (Larchmt)"},{"issue":"2","key":"zoi230947r11","doi-asserted-by":"publisher","first-page":"193","DOI":"10.2217\/WHE.14.80","article-title":"Next steps to reduce maternal morbidity and mortality in the USA.","volume":"11","author":"Kilpatrick","year":"2015","journal-title":"Womens Health (Lond)"},{"issue":"10350","key":"zoi230947r12","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1016\/S0140-6736(22)01480-5","article-title":"2022 heatwaves: a failure to proactively manage the risks.","volume":"400","author":"The Lancet","year":"2022","journal-title":"Lancet"},{"key":"zoi230947r13","doi-asserted-by":"publisher","first-page":"m3811","DOI":"10.1136\/bmj.m3811","article-title":"Associations between high temperatures in pregnancy and risk of preterm birth, low birth weight, and stillbirths: systematic review and meta-analysis.","volume":"371","author":"Chersich","year":"2020","journal-title":"BMJ"},{"issue":"1","key":"zoi230947r14","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s12940-021-00733-y","article-title":"Acute associations between heatwaves and preterm and early-term birth in 50 US metropolitan areas: a matched case-control study.","volume":"20","author":"Huang","year":"2021","journal-title":"Environ Health"},{"key":"zoi230947r15","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2021.106902","article-title":"Extreme heat, preterm birth, and stillbirth: a global analysis across 14 lower-middle income countries.","volume":"158","author":"McElroy","year":"2022","journal-title":"Environ Int"},{"issue":"5","key":"zoi230947r16","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1007\/s10995-021-03330-0","article-title":"An exploratory spatiotemporal analysis of socio-environmental patterns in severe maternal morbidity.","volume":"26","author":"Harden","year":"2022","journal-title":"Matern Child Health J"},{"issue":"4","key":"zoi230947r17","doi-asserted-by":"publisher","first-page":"2412","DOI":"10.3390\/ijerph19042412","article-title":"Extreme heat and pregnancy outcomes: a scoping review of the epidemiological evidence.","volume":"19","author":"Syed","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"10","key":"zoi230947r19","doi-asserted-by":"publisher","DOI":"10.1088\/1748-9326\/abb8a3","article-title":"Examining the joint effects of heatwaves, air pollution, and green space on the risk of preterm birth in California.","volume":"15","author":"Sun","year":"2020","journal-title":"Environ Res Lett"},{"issue":"1","key":"zoi230947r20","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1097\/AOG.0000000000000564","article-title":"Pregnancy-related mortality in the United States, 2006-2010.","volume":"125","author":"Creanga","year":"2015","journal-title":"Obstet Gynecol"},{"issue":"6","key":"zoi230947r21","doi-asserted-by":"publisher","first-page":"1302","DOI":"10.1097\/AOG.0b013e3181fdfb11","article-title":"Pregnancy-related mortality in the United States, 1998 to 2005.","volume":"116","author":"Berg","year":"2010","journal-title":"Obstet Gynecol"},{"issue":"1","key":"zoi230947r22","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/CIRCULATIONAHA.122.061832","article-title":"Associations between extreme temperatures and cardiovascular cause-specific mortality: results from 27 countries.","volume":"147","author":"Alahmad","year":"2023","journal-title":"Circulation"},{"issue":"11","key":"zoi230947r23","doi-asserted-by":"publisher","first-page":"1828","DOI":"10.1016\/j.cjca.2021.08.008","article-title":"Extreme heat and cardiovascular health: what a cardiovascular health professional should know.","volume":"37","author":"Chaseling","year":"2021","journal-title":"Can J Cardiol"},{"issue":"6","key":"zoi230947r24","doi-asserted-by":"publisher","first-page":"e484","DOI":"10.1016\/S2542-5196(22)00117-6","article-title":"Heat exposure and cardiovascular health outcomes: a systematic review and meta-analysis.","volume":"6","author":"Liu","year":"2022","journal-title":"Lancet Planet Health"},{"key":"zoi230947r25","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2021.106888","article-title":"Exposure to air pollutant mixture and gestational diabetes mellitus in Southern California: results from electronic health record data of a large pregnancy cohort.","volume":"158","author":"Sun","year":"2022","journal-title":"Environ Int"},{"key":"zoi230947r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2023.108030","article-title":"Maternal exposure to ambient air pollution mixture and premature rupture of membranes: evidence from a large cohort in Southern California (2008-2018).","volume":"177","author":"Jiao","year":"2023","journal-title":"Environ Int"},{"issue":"3","key":"zoi230947r28","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.whi.2023.01.001","article-title":"Racial disparities in severe maternal morbidity in an integrated health care system, Southern California, 2008-2017.","volume":"33","author":"Oakley","year":"2023","journal-title":"Womens Health Issues"},{"issue":"5","key":"zoi230947r29","doi-asserted-by":"publisher","first-page":"435.e1","DOI":"10.1016\/j.ajog.2013.11.039","article-title":"Racial and ethnic disparities in severe maternal morbidity: a multistate analysis, 2008-2010.","volume":"210","author":"Creanga","year":"2014","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"zoi230947r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2023.100882","article-title":"What we talk about when we talk about severe maternal morbidity: a call to action to critically review severe maternal morbidity as an outcome measure.","volume":"5","author":"Kern-Goldberger","year":"2023","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"1","key":"zoi230947r31","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1002\/joc.v33.1","article-title":"Development of gridded surface meteorological data for ecological applications and modelling.","volume":"33","author":"Abatzoglou","year":"2013","journal-title":"Int J Climatol"},{"key":"zoi230947r32","doi-asserted-by":"publisher","DOI":"10.1016\/j.envint.2020.105541","article-title":"Extreme heat episodes and risk of preterm birth in California, 2005-2013.","volume":"137","author":"Ilango","year":"2020","journal-title":"Environ Int"},{"key":"zoi230947r33","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.envint.2019.02.013","article-title":"Using deep learning to examine street view green and blue spaces and their associations with geriatric depression in Beijing, China.","volume":"126","author":"Helbich","year":"2019","journal-title":"Environ Int"},{"key":"zoi230947r34","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.socscimed.2018.05.022","article-title":"The effect of street-level greenery on walking behavior: evidence from Hong Kong.","volume":"208","author":"Lu","year":"2018","journal-title":"Soc Sci Med"},{"key":"zoi230947r35","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2021.147653","article-title":"Using machine learning to examine street green space types at a high spatial resolution: application in Los Angeles County on socioeconomic disparities in exposure.","volume":"787","author":"Sun","year":"2021","journal-title":"Sci Total Environ"},{"key":"zoi230947r36","doi-asserted-by":"publisher","DOI":"10.1016\/j.lana.2023.100462","article-title":"Association between urban green space and postpartum depression, and the role of physical activity: a retrospective cohort study in Southern California.","volume":"21","author":"Sun","year":"2023","journal-title":"Lancet Reg Health Am"},{"issue":"1","key":"zoi230947r38","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/s12874-022-01679-6","article-title":"Survival prediction models: an introduction to discrete-time modeling.","volume":"22","author":"Suresh","year":"2022","journal-title":"BMC Med Res Methodol"},{"issue":"2","key":"zoi230947r39","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.0561","article-title":"Association of long-term exposure to particulate air pollution with cardiovascular events in California.","volume":"6","author":"Alexeeff","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi230947r40","doi-asserted-by":"publisher","first-page":"233.e1","DOI":"10.1016\/j.ajog.2016.02.026","article-title":"Confirmed severe maternal morbidity is associated with high rate of preterm delivery.","volume":"215","author":"Kilpatrick","year":"2016","journal-title":"Am J Obstet Gynecol"},{"issue":"8","key":"zoi230947r41","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1007\/s10995-019-02744-1","article-title":"Severe maternal morbidity, a tale of 2 states using data for action\u2014Ohio and Massachusetts.","volume":"23","author":"Conrey","year":"2019","journal-title":"Matern Child Health J"},{"issue":"5","key":"zoi230947r42","first-page":"215","article-title":"Severe maternal morbidity during delivery hospitalizations.","volume":"116","author":"Gibson","year":"2017","journal-title":"WMJ"},{"issue":"11","key":"zoi230947r43","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.43225","article-title":"Association between housing affordability and severe maternal morbidity.","volume":"5","author":"Muchomba","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"12","key":"zoi230947r44","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0081959","article-title":"Pre-eclampsia increases the risk of postpartum haemorrhage: a nationwide cohort study in the Netherlands.","volume":"8","author":"von Schmidt auf Altenstadt","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"zoi230947r45","doi-asserted-by":"publisher","first-page":"51.e1","DOI":"10.1016\/j.ajog.2013.03.011","article-title":"Risk factors for uterine atony\/postpartum hemorrhage requiring treatment after vaginal delivery.","volume":"209","author":"Wetta","year":"2013","journal-title":"Am J Obstet Gynecol"},{"issue":"5","key":"zoi230947r46","doi-asserted-by":"publisher","first-page":"1368","DOI":"10.1213\/ANE.0b013e3181d74898","article-title":"The epidemiology of postpartum hemorrhage in a large, nationwide sample of deliveries.","volume":"110","author":"Bateman","year":"2010","journal-title":"Anesth Analg"},{"issue":"1","key":"zoi230947r47","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1186\/s12884-022-04859-w","article-title":"Short-term effects of ambient temperature on the risk of preeclampsia in Nanjing, China: a time-series analysis.","volume":"22","author":"Zhao","year":"2022","journal-title":"BMC Pregnancy Childbirth"},{"issue":"4","key":"zoi230947r48","doi-asserted-by":"publisher","first-page":"340","DOI":"10.3109\/10641955.2013.807820","article-title":"Blood pressure rises more in pre-eclampsia than normal pregnancy when acral skin is locally cooled.","volume":"32","author":"Hartgill","year":"2013","journal-title":"Hypertens Pregnancy"},{"issue":"4","key":"zoi230947r49","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1097\/00004872-200018040-00007","article-title":"Increased blood pressure response to the cold pressor test in pregnant women developing pre-eclampsia.","volume":"18","author":"Woisetschl\u00e4ger","year":"2000","journal-title":"J Hypertens"},{"issue":"4","key":"zoi230947r50","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.preghy.2015.06.002","article-title":"Cerebrovascular, cardiovascular and renal hypertensive disease after hypertensive disorders of pregnancy.","volume":"5","author":"Schokker","year":"2015","journal-title":"Pregnancy Hypertens"},{"key":"zoi230947r51","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.phrs.2017.11.003","article-title":"Hypertension and cardiovascular risk: general aspects.","volume":"129","author":"Kjeldsen","year":"2018","journal-title":"Pharmacol Res"},{"key":"zoi230947r52","doi-asserted-by":"publisher","DOI":"10.1016\/j.phrs.2021.105737","article-title":"Differences in the prevention and control of cardiovascular and cerebrovascular diseases.","volume":"170","author":"Liu","year":"2021","journal-title":"Pharmacol Res"},{"key":"zoi230947r53","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1016\/j.envres.2019.01.056","article-title":"Impact of summer heat on mortality and years of life lost: application of a novel indicator of daily excess hourly heat.","volume":"172","author":"Jiao","year":"2019","journal-title":"Environ Res"},{"issue":"1","key":"zoi230947r54","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.hlc.2022.10.010","article-title":"Extreme heat and adverse cardiovascular outcomes in Australia and New Zealand: what do we know?","volume":"32","author":"Chaseling","year":"2023","journal-title":"Heart Lung Circ"},{"issue":"Pt D","key":"zoi230947r55","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2022.113596","article-title":"Ambient temperature during pregnancy and risk of maternal hypertensive disorders: a time-to-event study in Johannesburg, South Africa.","volume":"212","author":"Part","year":"2022","journal-title":"Environ Res"},{"key":"zoi230947r56","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1016\/j.envpol.2018.06.045","article-title":"Effects of ambient temperature on myocardial infarction: a systematic review and meta-analysis.","volume":"241","author":"Sun","year":"2018","journal-title":"Environ Pollut"},{"issue":"24","key":"zoi230947r57","doi-asserted-by":"publisher","first-page":"2659","DOI":"10.1001\/jama.2014.15715","article-title":"Cause-specific risk of hospital admission related to extreme heat in older adults.","volume":"312","author":"Bobb","year":"2014","journal-title":"JAMA"},{"key":"zoi230947r58","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/1471-2393-14-77","article-title":"Severe maternal morbidity and maternal near miss in the extremes of reproductive age: results from a national cross\u2014sectional multicenter study.","volume":"14","author":"Oliveira","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"issue":"5","key":"zoi230947r59","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002307","article-title":"Maternal age and severe maternal morbidity: a population-based retrospective cohort study.","volume":"14","author":"Lisonkova","year":"2017","journal-title":"PLoS Med"},{"issue":"2","key":"zoi230947r60","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2021.100529","article-title":"Maternal age-specific drivers of severe maternal morbidity.","volume":"4","author":"Carr","year":"2022","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"1","key":"zoi230947r61","doi-asserted-by":"publisher","DOI":"10.1111\/nin.v29.1","article-title":"The lived experience of severe maternal morbidity among Black women.","volume":"29","author":"Canty","year":"2022","journal-title":"Nurs Inq"},{"issue":"2","key":"zoi230947r62","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/GRF.0000000000000349","article-title":"Reducing disparities in severe maternal morbidity and mortality.","volume":"61","author":"Howell","year":"2018","journal-title":"Clin Obstet Gynecol"},{"issue":"2","key":"zoi230947r63","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1097\/AOG.0000000000003667","article-title":"Race and ethnicity, medical insurance, and within-hospital severe maternal morbidity disparities.","volume":"135","author":"Howell","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"5","key":"zoi230947r64","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1097\/AOG.0000000000002937","article-title":"Racial and ethnic disparities in the incidence of severe maternal morbidity in the United States, 2012-2015.","volume":"132","author":"Admon","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"4","key":"zoi230947r65","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1007\/s40615-019-00577-w","article-title":"Racial and ethnic disparities in severe maternal morbidity in the United States.","volume":"6","author":"Liese","year":"2019","journal-title":"J Racial Ethn Health Disparities"},{"issue":"4","key":"zoi230947r66","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1093\/aje\/154.4.291","article-title":"Commentary: considerations for use of racial\/ethnic classification in etiologic research.","volume":"154","author":"Kaufman","year":"2001","journal-title":"Am J Epidemiol"},{"issue":"1","key":"zoi230947r67","doi-asserted-by":"publisher","first-page":"122.e1","DOI":"10.1016\/j.ajog.2015.08.019","article-title":"Black-white differences in severe maternal morbidity and site of care.","volume":"214","author":"Howell","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"zoi230947r68","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.envint.2016.02.029","article-title":"Green spaces and general health: roles of mental health status, social support, and physical activity.","volume":"91","author":"Dadvand","year":"2016","journal-title":"Environ Int"},{"key":"zoi230947r69","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.socscimed.2013.06.030","article-title":"Streetscape greenery and health: stress, social cohesion and physical activity as mediators.","volume":"94","author":"de Vries","year":"2013","journal-title":"Soc Sci Med"},{"key":"zoi230947r70","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1016\/j.envres.2017.06.028","article-title":"Exploring pathways linking greenspace to health: theoretical and methodological guidance.","volume":"158","author":"Markevych","year":"2017","journal-title":"Environ Res"},{"issue":"4","key":"zoi230947r71","doi-asserted-by":"publisher","DOI":"10.1016\/j.xinn.2021.100164","article-title":"Greenspace and human health: an umbrella review.","volume":"2","author":"Yang","year":"2021","journal-title":"Innovation (Camb)"},{"key":"zoi230947r37","volume-title":"Survival Analysis Using SAS: A Practical Guide","author":"Allison","year":"2010"},{"key":"zoi230947r1","unstructured":"US Centers for Disease Control and Prevention. Severe maternal morbidity in the United States. Accessed February 12, 2023. https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/severematernalmorbidity.html"},{"key":"zoi230947r8","unstructured":"US Centers for Disease Control and Prevention. Pregnancy mortality surveillance system. Accessed February 15, 2023. https:\/\/www.cdc.gov\/reproductivehealth\/maternal-mortality\/pregnancy-mortality-surveillance-system.htm"},{"key":"zoi230947r18","doi-asserted-by":"crossref","unstructured":"Jiao? A, Sun? Y, Sacks? DA, . The role of extreme heat exposure on premature rupture of membranes in Southern California: a study from a large pregnancy cohort. Environment International. 2023:107824.","DOI":"10.1016\/j.envint.2023.107824"},{"key":"zoi230947r27","unstructured":"US Centers for Disease Control and Prevention. How does CDC identify severe maternal morbidity? Accessed February 12, 2023. https:\/\/www.cdc.gov\/reproductivehealth\/maternalinfanthealth\/smm\/severe-morbidity-ICD.htm"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2809055\/jiao_2023_oi_230947_1692977930.67653.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T15:33:09Z","timestamp":1694100789000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2809055"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,7]]},"references-count":71,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9,5]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.32780","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,7]]}}}