How to use national data to cover trends in severe maternal morbidity

Women giving birth in the U.S. die at an alarmingly high rate compared with other rich nations, but maternal death is tricky to measure because it's rare, numbering in the hundreds per year. For journalists who want to track trends in the quality of maternal health, a more useful gauge may be the rate of severe maternal morbidity (SMM), which affects tens of thousands of women annually.

As with maternal death, SMM is often avoidable. It's associated with both adverse maternal and infant health outcomes and higher healthcare costs.

The Healthcare Cost and Utilization Project (HCUP), run by HHS' Agency for Healthcare Research and Quality, is a key source of SMM data.

Where to find HCUP data

You can find state-level severe maternal morbidity rates for the years 2010 through 2022 at AHRQ's Healthcare Cost and Utilization Project Fast Stats. A HCUP statistical brief posted in September provides trends for the years 2016-2021 by patient characteristic and type of complication.

About the data

According to AHRQ, HCUP is the nation's most comprehensive source of care data, providing policymakers with a vital source of information about outcomes, quality, cost and access to care.

Since the U.S. lacks a database of all hospital stays, HCUP calculates regional and national estimates using an all-payer database called the National Inpatient Sample (NIS), which contains billing records for about 7 million hospital stays annually.

Severe maternal morbidity rates are based on weighted estimates from the NIS using a composite of 20 indicators of unexpected outcomes of labor and delivery that may result in life-threatening complications to a woman's health. A record must indicate that the patient was female, aged 12-55 years, and had a diagnosis or procedure indicating both SMM and an in-hospital delivery.

The severe maternal morbidity rate does not reflect any complications that develop after a patient goes home. Another drawback is that up-to-date state-level data are not available for Idaho, New Hampshire, Nevada and Alabama.

Recent findings

According to the statistical report, the national SMM rate increased 40% from 2016 to 2021, from 72.0 to 101.1 per 10,000 delivery stays.

About half of that increase is associated with the pandemic. Among delivery stays without COVID-19, the SMM rate increased 21% from 72.0 per 10,000 in 2016 to 87.2 in 2021.

Being of Asian/Pacific Islander, nonHispanic race and ethnicity (56%); self-pay or no charge (48%); aged 12-19 and 20-24 years (44%); from a middle-level income area (43%); and from large metro area (42%) were factors associated with the largest increases over the six years.

Among possible complications, respiratory complications (137%), renal complications (119%) and sepsis (54%) increased most.

Finding experts at the local level

Ask public health officials and women's health experts what's driving the numbers in your state or region. For more background, check out the Commonwealth Fund issue brief, Severe Maternal Morbidity in the United States: A Primer.

Severe maternal morbidity trends are of particular interest in states where abortion care has been severely restricted. Former American Medical Association president Jack Resneck Jr., M.D., recently told Ms. Magazine that continuing a pregnancy poses "far greater danger" than medication abortion, with SMM risk being greatest for people of color, people with low incomes, and people in rural areas.

Resources

• Severe maternal morbidity in the United States: A Primer - Commonwealth Fund
• Severe maternal morbidity information page - CDC
• Maternal morbidity and well-being - World Health Organization