{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:02:10Z","timestamp":1792098130505,"version":"4.4.0"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"S 01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Objective\u2003For every incidence of maternal mortality, maternal morbidity is thought to occur in another 50 to 100 individuals in the United States. Multiple risk factors for severe maternal morbidity have been identified, but counseling about specific risk in pregnancy remains difficult, particularly nulliparous individuals as prior obstetric history is one of the factors influencing risk for severe maternal morbidity. The objective of this study is to examine the association between sociodemographic and laboratory assessments in the first trimester and maternal morbidity in nulliparas.<\/jats:p><jats:p>\n            Study Design\u2003This was a secondary analysis of a large, multicenter prospective observational cohort of nulliparas. The primary maternal outcome was a composite of hypertensive disorders of pregnancy (HDP), hemorrhage (transfusion, hemorrhage, hysterectomy, other surgery, readmission for bleeding), infection (endometritis, wound infection or dehiscence, pneumonia, sepsis, infection during labor and delivery, readmission for infection through day 14), venous thromboembolic events (VTE) (deep venous thrombosis, or pulmonary embolus), or maternal death within 14 days of delivery. Sociodemographic and clinical factors were compared between people with and without maternal morbidity. Relative risk and 95% confidence interval for maternal morbidity was calculated using log-binomial regression, adjusted for baseline characteristics that had a significant independent relationship with maternal morbidity with a p-value &lt;0.05.<\/jats:p><jats:p>\n            Results\u2003Of 9,445 pregnant people in the analysis, 18.2% (n\u2009=\u20091,716) experienced the composite maternal morbidity; the most common component was HDP (13.1%, n\u2009=\u20091,244) followed by infection (4.43%, n\u2009=\u2009420), hemorrhage (2.27%, n\u2009=\u2009215), VTE (0.12%, n\u2009=\u200911), and death (0.01%, n\u2009=\u20091). In a multivariable model, self-identified Black race, first trimester obesity, pregestational diabetes, chronic hypertension, and chronic kidney disease were significantly associated with the primary maternal outcome.<\/jats:p><jats:p>\n            Conclusion\u2003More than one in six nulliparas experienced the composite maternal morbidities. Maternal morbidity was associated with self-identified Black race, obesity, and multiple preexisting medical comorbidities.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2088-2586","type":"journal-article","created":{"date-parts":[[2023,5,7]],"date-time":"2023-05-07T22:30:21Z","timestamp":1683498621000},"page":"e1878-e1884","source":"Crossref","is-referenced-by-count":6,"special_numbering":"S","title":["Maternal Morbidity Risk Factors in Nulliparas"],"prefix":"10.1055","volume":"41","author":[{"given":"Audrey A.","family":"Merriam","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torri D.","family":"Metz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda A.","family":"Allshouse","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Silver","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Haas","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Indiana University, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"Grobman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyagriv N.","family":"Simhan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald J.","family":"Wapner","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Wing","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of California-Irvine, Irvine, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Mercer","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Parry","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uma M.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"+nuMoM2b Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,6,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:103855","volume-title":"Maternal mortality rates in the United States, 2019","author":"D L Hoyert","year":"2021"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","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":"W M 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