{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:13:19Z","timestamp":1771927999997,"version":"3.50.1"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:p>\n            Objective\u2003Maternal risk stratification systems are increasingly employed in predicting and preventing obstetric complications. These systems focus primarily on maternal morbidity, and few tools exist to stratify neonatal risk. We sought to determine if a maternal risk stratification score was associated with neonatal morbidity.<\/jats:p><jats:p>\n            Study Design\u2003Retrospective cohort study of patients with liveborn infants born at \u226524 weeks at four hospitals in one health system between January 1, 2020, and December 31, 2020. The Expanded Obstetric Comorbidity Score (EOCS) is used as the maternal risk score. The primary neonatal outcome was 5-minute Apgar &lt;7. Logistic regression models determined associations between EOCS and neonatal morbidity. Secondary analyses were performed, including stratifying outcomes by gestational age and limiting analysis to \u201clow-risk\u201d term singletons. Model discrimination assessed using the area under the receiver operating characteristic curves (AUC) and calibration via calibration plots.<\/jats:p><jats:p>\n            Results\u2003A total of 14,497 maternal\u2013neonatal pairs were included; 236 (1.6%) had 5-minute Apgar &lt;7; EOCS was higher in 5-minute Apgar &lt;7 group (median 41 vs. 11, p\u2009&lt;\u20090.001). AUC for EOCS in predicting Apgar &lt;7 was 0.72 (95% Confidence Interval (CI) 0.68, 0.75), demonstrating relatively good discrimination. Calibration plot revealed that those in the highest EOCS decile had higher risk of neonatal morbidity (7.6 vs. 1.7%, p\u2009&lt;\u20090.001). When stratified by gestational age, discrimination weakened with advancing gestational age: AUC 0.70 for &lt;28 weeks, 0.63 for 28 to 31 weeks, 0.64 for 32 to 36 weeks, and 0.61 for \u226537 weeks. When limited to term low-risk singletons, EOCS had lower discrimination for predicting neonatal morbidity and was not well calibrated.<\/jats:p><jats:p>\n            Conclusion\u2003A maternal morbidity risk stratification system does not perform well in most patients giving birth, at low risk for neonatal complications. The findings suggest that the association between EOCS and 5-minute Apgar &lt;7 likely reflects a relationship with prematurity. This study cautions against intentional or unintentional extrapolation of maternal morbidity risk for neonatal risk, especially for term deliveries.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2259-0472","type":"journal-article","created":{"date-parts":[[2024,2,1]],"date-time":"2024-02-01T23:57:21Z","timestamp":1706831841000},"page":"1808-1814","source":"Crossref","is-referenced-by-count":2,"title":["Performance of a Maternal Risk Stratification System for Predicting Low Apgar Scores"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0865-8109","authenticated-orcid":false,"given":"Thomas P.","family":"Kishkovich","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaitlyn E.","family":"James","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas H.","family":"McCoy","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Center for Quantitative Health, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy H.","family":"Perlis","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Center for Quantitative Health, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anjali J.","family":"Kaimal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5568-4444","authenticated-orcid":false,"given":"Mark A.","family":"Clapp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,3,1]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1097\/AOG.0b013e3182a603bb","article-title":"Development of a comorbidity index for use in obstetric patients","volume":"122","author":"B T Bateman","year":"2013","journal-title":"Obstet Gynecol"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"271.e1","DOI":"10.1016\/j.ajog.2019.06.025","article-title":"A comorbidity-based screening tool to predict severe maternal morbidity at the time of delivery","volume":"221","author":"S R Easter","year":"2019","journal-title":"Am J Obstet Gynecol"},{"issue":"06","key":"ref3","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1213\/ANE.0000000000003889","article-title":"National partnership for maternal safety recommended 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Ratnasiri","year":"2020","journal-title":"PLoS ONE"},{"issue":"11","key":"ref15","doi-asserted-by":"crossref","first-page":"e2026750","DOI":"10.1001\/jamanetworkopen.2020.26750","article-title":"Predictive modeling for perinatal mortality in resource-limited settings","volume":"3","author":"V V Shukla","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1111\/ppe.12847","article-title":"Antepartum severe maternal morbidity: a population-based study of risk factors and delivery outcomes","volume":"36","author":"M Raineau","year":"2022","journal-title":"Paediatr Perinat Epidemiol"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.3390\/jcm10061319","article-title":"Factors associated with increased risk of early severe neonatal morbidity in late preterm and early term infants","volume":"10","author":"T S Mengistu","year":"2021","journal-title":"J Clin 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