{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T05:25:34Z","timestamp":1794029134562,"version":"4.8.0"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2]]},"abstract":"\n OBJECTIVE:<\/jats:title>\n To assess whether application of a standard algorithm to hospitalizations in the prenatal and postpartum (42 days) periods increases identification of severe maternal morbidity (SMM) beyond analysis of only the delivery event.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n We performed a retrospective cohort study using data from the PELL (Pregnancy to Early Life Longitudinal) database, a Massachusetts population-based data system that links records from birth certificates to delivery hospital discharge records and nonbirth hospital records for all birthing individuals. We included deliveries from January 1, 2009, to December 31, 2018, distinguishing between International Classification of Diseases Ninth (ICD-9) and Tenth Revision (ICD-10) coding. We applied the modified Centers for Disease Control and Prevention algorithm for SMM used by the Alliance for Innovation on Maternal Health to hospitalizations across the antenatal period through 42 days postpartum. Morbidity was examined both with and without blood transfusion.<\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n Overall, 594,056 deliveries were included in the analysis, and 3,947 deliveries met criteria for SMM at delivery without transfusion and 9,593 with transfusion for aggregate rates of 150.1 (95% CI 146.7\u2013153.5) using ICD-9 codes and 196.6 (95% CI 189.5\u2013203.7) using ICD-10 codes per 10,000 deliveries. Severe maternal morbidity at birth increased steadily across both ICD-9 and ICD-10 from 129.4 in 2009 (95% CI 126.2\u2013132.6) using ICD-9 to 214.3 per 10,000 (95% CI 206.9\u2013221.8) in 2018 using ICD-10. Adding prenatal and postpartum hospitalizations increased cases by 21.9% under both ICD-9 and ICD-10, resulting in a 2018 rate of 258.7 per 10,000 (95% CI 250.5\u2013266.9). The largest increase in detected morbidity in the prenatal or postpartum time period was attributed to sepsis cases.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION:<\/jats:title>\n Inclusion of prenatal and postpartum hospitalizations in the identification of SMM resulted in increased ascertainment of morbid events. These results suggest a need to ensure surveillance of care quality activities beyond the birth event.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/aog.0000000000004641","type":"journal-article","created":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T17:10:50Z","timestamp":1641489050000},"page":"165-171","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":54,"title":["Using Longitudinally Linked Data to Measure Severe Maternal Morbidity"],"prefix":"10.1097","volume":"139","author":[{"given":"Eugene R.","family":"Declercq","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard J.","family":"Cabral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Ling","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ndidiamaka","family":"Amutah-Onukagha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elysia","family":"Larson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audra","family":"Meadows","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafsatou","family":"Diop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,1,5]]},"reference":[{"key":"R3-20261107","first-page":"135","article-title":"Defining a conceptual framework for near-miss maternal morbidity","volume":"57","author":"Geller","year":"2002","journal-title":"J Am Med Womens Assoc"},{"key":"R4-20261107","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":"Callaghan","year":"2012","journal-title":"Obstet Gynecol"},{"key":"R5-20261107","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1097\/AOG.0000000000004057","article-title":"Associations between comorbidities and severe maternal morbidity","volume":"136","author":"Brown","year":"2020","journal-title":"Obstet Gynecol"},{"key":"R6-20261107","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1089\/jwh.2017.6437","article-title":"Severe maternal morbidity at delivery and risk of hospital encounters within 6 weeks and 1 year postpartum","volume":"27","author":"Harvey","year":"2017","journal-title":"J Women's Health"},{"key":"R7-20261107","doi-asserted-by":"crossref","first-page":"e2036148","DOI":"10.1001\/jamanetworkopen.2020.36148","article-title":"Assessment of incidence and factors associated with severe maternal morbidity after delivery discharge among women in the US","volume":"4","author":"Chen","year":"2021","journal-title":"JAMA Netw Open"},{"key":"R8-20261107","doi-asserted-by":"crossref","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"},{"key":"R9-20261107","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/GRF.0000000000000375","article-title":"Severe maternal or near miss morbidity: implications for public health surveillance and clinical audit","volume":"61","author":"Kuklina","year":"2018","journal-title":"Clin Obstet Gynecol"},{"key":"R11-20261107","doi-asserted-by":"crossref","first-page":"423","DOI":"10.15585\/mmwr.mm6818e1","article-title":"Vital signs: pregnancy-related deaths, United States, 2011\u20132015, and strategies for prevention, 13 states, 2013\u20132017","volume":"68","author":"Petersen","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"R14-20261107","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/j.fertnstert.2014.01.053","article-title":"Calculating length of gestation from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database versus vital records may alter reported rates of prematurity","volume":"101","author":"Stern","year":"2014","journal-title":"Fertil Steril"},{"key":"R15-20261107","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/GRF.0000000000000363","article-title":"The alliance for innovation in maternal health care: a way forward","volume":"61","author":"Mahoney","year":"2018","journal-title":"Clin Obstet Gynecol"},{"key":"R17-20261107","first-page":"599","article-title":"Ectopic pregnancy: diagnosis and management","volume":"101","author":"Hendriks","year":"2020","journal-title":"Am Fam Physician"},{"key":"R18-20261107","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1097\/AOG.0000000000003279","article-title":"Pregnancy-associated death in Utah: contribution of drug-induced deaths","volume":"133","author":"Smid","year":"2019","journal-title":"Obstet Gynecol"},{"key":"R19-20261107","doi-asserted-by":"crossref","first-page":"1828","DOI":"10.2105\/AJPH.2020.305888","article-title":"Racial and ethnic disparities in maternal and infant outcomes among opioid-exposed mother-infant dyads in Massachusetts (2017-2019)","volume":"110","author":"Peeler","year":"2020","journal-title":"Am J Public Health"},{"key":"R20-20261107","doi-asserted-by":"crossref","first-page":"489.e1","DOI":"10.1016\/j.ajog.2019.05.045","article-title":"Maternal drug-related death and suicide are leading causes of postpartum death in California","volume":"221","author":"Goldman-Mellor","year":"2019","journal-title":"Am J Obstet Gynecol"},{"key":"R23-20261107","doi-asserted-by":"crossref","first-page":"643.e1","DOI":"10.1016\/j.ajog.2015.11.004","article-title":"Measuring severe maternal morbidity: validation of potential measures","volume":"214","author":"Main","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"R24-20261107","doi-asserted-by":"crossref","first-page":"103152","DOI":"10.1016\/j.jbi.2019.103152","article-title":"Creating the first national linked dataset on perinatal and maternal outcomes in Australia: methods and challenges","volume":"93","author":"Cheah","year":"2019","journal-title":"J Biomed Inform"}],"container-title":["Obstetrics & Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/AOG.0000000000004641","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T05:00:19Z","timestamp":1794027619000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/AOG.0000000000004641"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,5]]},"references-count":16,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1097\/aog.0000000000004641","relation":{},"ISSN":["0029-7844","1873-233X"],"issn-type":[{"value":"0029-7844","type":"print"},{"value":"1873-233X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,5]]},"assertion":[{"value":"2021-08-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-21","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}