Severe maternal morbidity: Are we doing enough?

A wide range of risk factors and pre-existing health conditions contribute to the identification of high-risk pregnancy. High-risk pregnancy can lead to severe maternal morbidity (SMM), which is diagnosed during or after childbirth when life-threatening complications occur. Maternity care services are critical for addressing the conditions and risk factors associated with high-risk pregnancy to prevent SMM. Without a two-pronged approach to 1) the identification, classification, and measurement of high-risk pregnancy and SMM cases and outcomes, along with 2) the timely delivery of maternity care services and interventions to prevent SMM, mothers and infants will continue to face avoidable harm.

The cost and impact of severe maternal complications

While serious maternal illnesses and complications are rare, they can be both tragic and costly. There are approximately 60,000 complications and 700 deaths out of 3.7 million births annually. This does not even include prenatal or postpartum morbidities. Severe maternal morbidity (SMM) is much more common within certain populations, including non-Hispanic Black populations, those who are under 20 or over 40 years old, have a low income, or are enrolled in Medicaid. Postpartum hospital admissions within six weeks of delivery, as well as readmissions within one year of delivery, are higher for women who experienced SMM. Hospital admissions, readmissions, emergency room visits and other emergent care are key contributors to the costs associated with SMM.

Access to labor and delivery services and inpatient obstetric and newborn care services is becoming increasingly problematic as hospitals contend with declining birth rates, staff shortages and inadequate Medicaid reimbursement, while pivoting towards more profitable women’s specialty services. The closure of 300 maternity wings since 2018 has essentially created “maternity care deserts” that disproportionately affect rural, low-income and Black women.

NICU admissions rise despite declining birth rates

One paradox is that as the national birth rate declines, the number of neonatal intensive care unit (NICU) admissions is increasing. According to a recent report by the Centers for Disease Control and Prevention (CDC), the percentage of infants admitted to the NICU rose from 8.7% of births in 2016 to 9.8% in 2023. This increase occurred across all maternal age groups, as well as each race and Hispanic-origin group, although NICU admittance rates remained highest for those born to non-Hispanic Black mothers or those over 40 years old.

Improving maternal care through data and risk adjustment

It is important to measure maternal and child health outcomes across the entire continuum of pregnancy, delivery and the postpartum period. Hospitals, health plans and government agencies must be able to risk adjust outcomes across care sites to effectively compare the success of interventions designed to reduce SMM.

It is also important to expand the scope of SMM beyond the 21 indicators provided by the CDC. Hospital admissions, emergency room visits and urgent care visits that occur postpartum can also be indicative of maternal morbidity. Methodologies that highlight complications and track other potentially preventable events ultimately allow practitioners and healthcare systems to address the healthcare needs of pregnant and parenting mothers and better understand the difference they are making in the lives of the mothers and infants they treat.

Steve Delaronde is senior manager of product, regulatory and payment solutions, Solventum. With over 20 years of experience delivering analytics and value-based care solutions for payers and providers. He holds dual master’s degrees in public health and social work from the University of Connecticut, where he also teaches as an adjunct professor.