Stillbirth is associated with postpartum severe maternal morbidity compared with gestational age matched and term live births

Abstract

BACKGROUND: The rates of severe maternal morbidity in the United States continue to increase. The American College of Obstetricians and Gynecologists recommends close postpartum follow-up for patients at increased risk for severe maternal morbidity and mortality, such as those who suffer from preeclampsia or hypertension. Data on the association between stillbirth and severe maternal morbidity are limited. OBJECTIVE: This study aimed to evaluate the association between stillbirth and severe maternal morbidity in comparison with gestational age–matched and term live births. STUDY DESIGN: This was a multicenter, retrospective cohort study that was performed at 3 centers within a hospital system from 2017 to 2023. Severe maternal morbidity was defined with guidance from the indicators outlined by the Centers for Disease Control and Prevention. The inclusion criteria for the stillbirth group were delivery of a fetus that showed no signs of life at 20 weeks’ gestation or later. Cases with antepartum preeclampsia, multiple gestations, maternal age less than 18 years, duplicate records, and voluntary terminations of the pregnancy after 20 weeks’ gestation were excluded. We selected gestational age- and term-matched live births as the control groups. A logistic regression analysis was performed to evaluate the odds of the composite severe maternal morbidity in stillbirths vs gestational age–matched and term-matched live births, separately, with adjustment for potential confounders. The data were presented as the adjusted odds ratios with 95% confidence intervals, and statistical significance was set at a P value of