Severe Maternal Morbidity after Delivery Discharge among U.S. Women, 2010-2014

Background
  • Severe maternal morbidity (SMM) includes a range of serious pregnancy complications that result in significant short-term or long-term consequences to a woman’s health.
  • Most research and prevention efforts addressing SMM focus on the delivery hospitalization.
  • Less is known about SMM diagnosed after delivery discharge.
The Burden

A significant number of women have severe complications that start after they leave the hospital. One in seven SMM cases among commercially-insured women, and almost one in six SMM cases among Medicaid-insured women first developed after delivery discharge.

vector image of seven mothers carrying their babies

Commercially-insured

vector image of six mothers carrying their babies

Medically-insured

Timing of SMM After Delivery Discharge

Of SMM cases that were identified within the first six weeks (42 days) after delivery discharge, about three-quarters were identified in the first two weeks.

This is a bar chart of commercially-insured SMM cases that were identified within the first six weeks (42 days) after delivery discharge. Week 1: 50%; Week 2: 24%; Week 3: 9%; Week 4: 7%; Week 5: 6%; Week 6: 4%.

Commercially-insured

This is a bar chart of medically-insured SMM cases that were identified within the first six weeks (42 days) after delivery discharge. Week 1: 47%; Week 2: 25%; Week 3: 10%; Week 4: 8%; Week 5: 5%; Week 6: 6%.

Medically-insured

The Most Common SMM Indicators after Delivery Discharge
The Most Common SMM Indicators after Delivery Discharge: Blood transfusion Pulmonary edema / Acute heart failure Sepsis Adult respiratory distress syndrome Air and thrombotic embolism Eclampsia Puerperal cerebrovascular disorders Acute Renal Failure
Disparities in SMM

Racial disparities in SMM after delivery discharge persist. Among deliveries insured by Medicaid, the odds of SMM among Black women are about 1.7 times more likely than White women.

The Way Forward

Expanding the focus of SMM to those diagnosed after delivery discharge and continued monitoring of SMM may:

  • improve our understanding of the burden and impact of SMM, and
  • create new opportunities to improve maternity and postpartum care.