{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:52:34Z","timestamp":1792785154131,"version":"4.5.0"},"reference-count":7,"publisher":"Georg Thieme Verlag KG","issue":"13","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"U.S. Department of Health and Human Services, U.S. Public Health Service, Agency for Healthcare Research and Quality","award":["47QRAA18D00BQ"],"award-info":[{"award-number":["47QRAA18D00BQ"]}],"id":[{"id":"https:\/\/ror.org\/033jnv181","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Severe maternal morbidity (SMM) is a growing public health concern in the United States. While existing measures capture SMM-related complications during the delivery hospitalization, patients may also experience serious complications after discharge that affect long-term health, mortality, and health care utilization. We aimed to assess the frequency of SMM events occurring after hospital discharge and identify the appropriate postdischarge window for measurement.<\/jats:p>\n                  <jats:p>We analyzed 2019 to 2021 delivery hospitalizations among women aged 12 to 55 years using the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases from 17 states, with follow-up through 2021. SMM was identified per AHRQ measure specifications in inpatient and emergency department encounters. We calculated overall SMM rates as well as specific SMM-related complications, during delivery hospitalization and after discharge.<\/jats:p>\n                  <jats:p>The SMM rate during delivery hospitalization was 87.1 per 10,000 deliveries. Extending the measurement period through 42 days' postdischarge increased the cumulative SMM rate by 32.1% to 115.0 per 10,000 deliveries. More than 80% of SMM events observed within 90 days occurred in the first 42 days after discharge, and 78.6% of these were treated in inpatient settings. Coagulopathy (26.0 per 10,000), acute renal failure (21.4 per 10,000), and sepsis (25.3 per 10,000) had the highest cumulative rates through 42 days' postdischarge. Coagulopathy was the most common complication during the delivery hospitalization (27.7%), whereas sepsis emerged as the most frequent condition treated in the 42 days after discharge (34.4%).<\/jats:p>\n                  <jats:p>Our study highlights the importance of including the postpartum period when measuring SMM. Most events were treated in an inpatient setting, and the majority occurred within 42 days after delivery. To address SMM, research and policy warrants focus on maternal health during and after the delivery hospitalization.<\/jats:p>","DOI":"10.1055\/a-2817-3616","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:42:31Z","timestamp":1772152951000},"page":"1834-1838","source":"Crossref","is-referenced-by-count":0,"title":["Severe Maternal Morbidity with the Inclusion of Events after Delivery Hospitalization"],"prefix":"10.1055","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8439-0794","authenticated-orcid":false,"given":"Karen L.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Nutrition, Health, and Human Services Division, Mathematica, Inc., Princeton, New Jersey, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keri L.","family":"Calkins","sequence":"additional","affiliation":[{"name":"Nutrition, Health, and Human Services Division, Mathematica, Inc., Princeton, New Jersey, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick S.","family":"Romano","sequence":"additional","affiliation":[{"name":"Division of General Medicine and Bioethics, Department of Internal Medicine and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judy","family":"George","sequence":"additional","affiliation":[{"name":"Quality Indicators Program, Agency for Healthcare Research and Quality, Rockville, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney","family":"Schott","sequence":"additional","affiliation":[{"name":"Quality Indicators Program, Agency for Healthcare Research and Quality, Rockville, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5861-7017","authenticated-orcid":false,"given":"Leanna S.","family":"Sudhof","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, California, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"issue":"06","key":"ref1","doi-asserted-by":"crossref","first-page":"e2317641","DOI":"10.1001\/jamanetworkopen.2023.17641","article-title":"Trends in maternal mortality and severe maternal morbidity during delivery-related hospitalizations in the United States, 2008 to 2021","volume":"6","author":"D A Fink","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"13","key":"ref2","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1055\/s-0038-1649481","article-title":"Severe maternal morbidity and hospital cost among hospitalized deliveries in the United States","volume":"35","author":"H Y Chen","year":"2018","journal-title":"Am J Perinatol"},{"issue":"04","key":"ref3","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.whi.2021.12.006","article-title":"A comprehensive analysis of the costs of severe maternal morbidity","volume":"32","author":"C M Phibbs","year":"2022","journal-title":"Womens Health Issues"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1097\/AOG.0000000000005116","article-title":"Severe maternal morbidity review and preventability assessment in a large academic center","volume":"141","author":"O Grechukhina","year":"2023","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1097\/AOG.0000000000004641","article-title":"Using longitudinally linked data to measure severe maternal morbidity","volume":"139","author":"E R Declercq","year":"2022","journal-title":"Obstet Gynecol"},{"issue":"09","key":"ref10","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1093\/aje\/kwab077","article-title":"Severe maternal morbidity: a comparison of definitions and data sources","volume":"190","author":"J M Snowden","year":"2021","journal-title":"Am J Epidemiol"},{"issue":"05","key":"ref11","doi-asserted-by":"crossref","first-page":"e140","DOI":"10.1097\/AOG.0000000000002633","article-title":"ACOG Committee Opinion no. 736: optimizing postpartum care","volume":"131","author":"American College of Obstetricians and Gynecologists","year":"2018","journal-title":"Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2817-3616.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:42:18Z","timestamp":1789598538000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2817-3616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":7,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,9,16]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2817-3616","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,2,26]]},"published":{"date-parts":[[2026,2,26]]}}}