{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T17:55:52Z","timestamp":1782496552359,"version":"3.54.5"},"reference-count":81,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["2022-8041"],"award-info":[{"award-number":["2022-8041"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,9]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess health service use between days 43 and 365 postdelivery, comparing individuals with and without severe maternal morbidity (SMM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Population-based cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Linked datasets from Population Data BC in British Columbia, Canada, April 2013\u2013March 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Postpartum individuals aged &gt;18 years with a hospital or home delivery, with\/without SMM occurring from 20 weeks\u2019 gestation through 42 days post partum. Ectopic pregnancies, missing identifiers and maternal deaths at delivery or within 42 days post partum were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was high health service use, defined as being in the 95th percentile for use of one or more of the following non-obstetric visits: emergency department, hospitalisations and outpatient visits to a primary care physician or specialist\u2014each occurring between 43 and 365 days after delivery hospitalisation discharge. Secondary outcomes included being in the 95th percentile for each visit type. Log binomial regression assessed the rate and risk of high health service use in SMM compared with non-SMM pregnancies, adjusting for confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 261\u2009287 deliveries (5575 (2.1%) with SMM). Those with &gt;15 visits within 43\u2013365\u2009days postdelivery were classified as having high health service use. SMM-affected individuals were twice as likely to have high health service use (9.2% vs 4.3%; adjusted relative risk (aRR)=1.96, 95%\u2009CI 1.78 to 2.17). Individuals with non-hypertensive cardiovascular SMM had markedly higher health service use (21.4% vs 4.3%; aRR=5.18, 95%\u2009CI 3.28 to 8.16). There was heterogeneity in the association between SMM and high health service use among those without versus with previous comorbidities, without versus with high service use in the 2 years prior to delivery, and without vs with preterm birth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study revealed high health service use after SMM. These findings can help guide the development of standardised postpartum care pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110105","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T14:56:10Z","timestamp":1770389770000},"page":"e110105","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association between severe maternal morbidity and health service use in the first postpartum year: a population-based retrospective cohort study in British Columbia, Canada"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8233-2875","authenticated-orcid":false,"given":"Lauren","family":"Tanner","sequence":"first","affiliation":[{"name":"Division of Clinical and Translational Research, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1220-310X","authenticated-orcid":false,"given":"Sarka","family":"Lisonkova","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3139-0238","authenticated-orcid":false,"given":"Gabriel D","family":"Shapiro","sequence":"additional","affiliation":[{"name":"Research Institute, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6175-3634","authenticated-orcid":false,"given":"Dimitra","family":"Panagiotoglou","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W","family":"Platt","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada"},{"name":"Department of Paediatrics, McGill University, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugochinyere","family":"Ukah","sequence":"additional","affiliation":[{"name":"Research Institute, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Dayan","sequence":"additional","affiliation":[{"name":"Division of Clinical and Translational Research, McGill University, Montreal, Quebec, Canada"},{"name":"Research Institute, McGill University Health Centre, Montreal, Quebec, Canada"},{"name":"Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada"},{"name":"Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"2026062610411757000_16.2.e110105.1","doi-asserted-by":"publisher","DOI":"10.1111\/PPE.12574"},{"key":"2026062610411757000_16.2.e110105.2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwab077"},{"key":"2026062610411757000_16.2.e110105.3","doi-asserted-by":"publisher","DOI":"10.1111\/ppe.12011"},{"key":"2026062610411757000_16.2.e110105.4","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.9875","article-title":"Association of Maternal Age With Severe Maternal Morbidity and Mortality in Canada","volume":"2","author":"Aoyama","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026062610411757000_16.2.e110105.5","doi-asserted-by":"crossref","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":"Fink","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026062610411757000_16.2.e110105.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0091735","article-title":"Partner experiences of \u201cnear-miss\u201d events in pregnancy and childbirth in the UK: a qualitative study","volume":"9","author":"Hinton","year":"2014","journal-title":"PLoS One"},{"key":"2026062610411757000_16.2.e110105.7","unstructured":"Government of Canada . 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