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Contrasts between regions were quantified using rate ratios (RRs) and 95% confidence intervals (95%\u2009CIs). Temporal changes in SMM types and subtypes were described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Types and subtypes of SMM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 59\u2009789 SMM cases among 2\u2009212\u2009576 deliveries, corresponding to 270.2 (95%\u2009CI 268.1\u2013272.4) per 10\u2009000 deliveries. Composite SMM rates increased from 236.6 per 10\u2009000 deliveries in 1999 to 307.3 per 10\u2009000 deliveries in 2006, before declining to 253.8 per 10\u2009000 deliveries in 2019. Changes in composite SMM corresponded with temporal changes in severe haemorrhage rates, which increased from 94.9 per 10\u2009000 deliveries in 1999 to 169.3 per 10\u2009000 deliveries in 2006, before declining to 111.2 per 10\u2009000 deliveries in 2019. Severe pre\u2010eclampsia, eclampsia and HELLP (haemolysis, elevated liver enzymes and low platelet count) syndrome (103.8 per 10\u2009000 deliveries), severe haemorrhage (133.7 per 10\u2009000 deliveries), sepsis, embolism, disseminated intravascular coagulation, shock and severe mental health disorders were the most common SMM types. Rates of embolism, disseminated intravascular coagulation and shock, acute renal failure, cardiac complications, sepsis and assisted ventilation increased, whereas rates of surgical complications, severe uterine rupture and anaesthesia complications declined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The observed spatiotemporal variations in composite SMM and SMM types provide substantive insights and highlight regional priorities for improving maternal health.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17686","type":"journal-article","created":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T17:35:14Z","timestamp":1696613714000},"page":"811-822","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Severe maternal morbidity surveillance, temporal trends and regional variation: A population\u2010based cohort study"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5534-559X","authenticated-orcid":false,"given":"Eleni","family":"Tsamantioti","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine Solna Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2879-4271","authenticated-orcid":false,"given":"Anna","family":"Sandstr\u00f6m","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine Solna Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4618-0839","authenticated-orcid":false,"given":"Giulia M.","family":"Muraca","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Division, Department of Medicine Solna Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Obstetrics and Gynaecology, Faculty of Health Sciences McMaster University  Hamilton Ontario Canada"},{"name":"Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences McMaster University  Hamilton Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. 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