Double, Triple, and Quadruple Jeopardy: Entering Pregnancy With Two or More Multimorbid Diagnoses and Increased Risk of Severe Maternal Morbidity and Postpartum Readmission



      Multimorbidity, the presence of two or more chronic disease diagnoses, is associated with an increased risk of mortality and high health care costs in the general population and older adults. However, little evidence is available about the prevalence and impact of multimorbidity in obstetric populations. The goal of this analysis was to estimate the association between multimorbidity and severe maternal morbidity (SMM) and 90-day postpartum readmission in an obstetric cohort in Atlanta, Georgia.

      Study Design

      We conducted a retrospective cohort study of livebirths and stillbirths at Grady Memorial Hospital, from October 2015 to April 2021. To determine preexisting chronic conditions, we linked information on births to inpatient diagnoses within the prior year. Multimorbidity was defined as the presence of two or more chronic disease diagnoses at birth or within the prior year. We conducted multivariable log binomial regression to estimate risk ratios and 95% confidence intervals for the crude and adjusted (for age, race/ethnicity, parity, and insurance) association between multimorbidity (two or more chronic conditions vs. zero or one) and SMM (at or within 42 days after birth) or 90-day postpartum readmission for any reason.


      Of 14,225 included births, 10.1% were to patients with multimorbidity. Overall, SMM complicated 7.5% of births, and the 90-day readmission rate was 2.4%. Both SMM and readmission were more common among women with multimorbidity (SMM, 18.6% among women with multimorbidity compared with 6.3% without; 90-day readmission, 5.4% compared with 2.1%). Adjusting for potential confounders, multimorbidity was associated with increased risk of SMM (adjusted risk ratio, 2.9; 95% confidence interval, 2.5–3.0) and readmission (adjusted risk ratio, 2.2; 95% confidence interval, 1.7–2.9).


      Individuals entering pregnancy with two or more chronic diseases were at an increased risk of SMM and postpartum readmission compared with individuals with one or zero chronic disease diagnoses.
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      Kaitlyn Stanhope, PhD, is a social epidemiologist focused on understanding the role of structural and social factors in perinatal health for vulnerable communities in the Southeast.


      Nikkia Worrell, MD, is an obstetrician-gynecologist and quality improvement specialist who focuses on understanding and implementing quality improvement bundles for pregnant and postpartum populations.


      Franklyn Geary, Jr, MD, is an obstetrician-gynecologist focused on caring for and improving outcomes for pregnant people in safety-net hospitals with expertise in hypertensive disorders of pregnancy.


      Denise Jamieson, MD, is an obstetrician-gynecologist and clinical researcher focusing on designing and testing clinical interventions to improve outcomes for pregnant people in safety-net hospitals.


      Sheree Boulet, DrPH, is a perinatal epidemiologist and health services researcher focused on understanding and addressing maternal health disparities.