TOPLINE:

Individuals who experienced severe maternal morbidity in the first birth had an over threefold higher risk for the same in the second birth than those who did not experience severe morbidity during the first birth.

METHODOLOGY:

• Researchers analyzed a large dataset of close to 2 million pairs of mothers and infants in California from 1997 to 2020 to assess the recurrence of severe maternal morbidity, defined as unexpected outcomes of labor and delivery that result in short- or long-term health consequences for the mother. Examples include severe bleeding, high blood pressure disorders such as preeclampsia, and infections.
• Severe maternal morbidity was identified during pregnancy, at hospitalization for birth, and up to 42 days postpartum, with its occurrence in the first birth as the exposure and in the second birth as the outcome.
• The measure was identified using diagnostic codes for 21 indicators, categorized into eight subtypes.
• The study examined risks for the recurrence, considering factors such as age, race or ethnicity, and socioeconomic status.

TAKEAWAY:

• The prevalence of severe maternal morbidity was 12 cases per 1000 first births and 11 per 1000 second births. Women with it in their first births had over a threefold increased risk for recurrence in second births (adjusted risk ratio [aRR], 3.4; 95% CI, 2.9-4.1).
• Cardiac and other medical severe maternal morbidity subtypes showed highly increased risks for recurrence (aRR, 32.6; 95% CI, 6.6-88.4 and aRR, 119; 95% CI, 30-267, respectively).
• Highest risks for recurrence were noted among those aged 20-39 years, with private insurance or no insurance, or with a lower comorbidity index.
• Hispanic individuals had a lower risk for the recurrence than White, Black, or Asian American individuals.

IN PRACTICE:

“These findings highlight populations among whom there is opportunity to improve the quality of prenatal, peripartum, and postnatal care. Individuals who experience SMM [severe maternal morbidity] in their first pregnancy and desire a subsequent pregnancy may require personalized counselling on reproductive planning, as well as preventative care for health conditions between pregnancies, and prenatal care,” the authors of the study wrote.

SOURCE:

The study was led by Shalmali Bane, Division of Research, Kaiser Permanente Northern California, Pleasanton, California. It was published online on November 10, 2025, in the American Journal of Obstetrics and Gynecology.

LIMITATIONS:

Severe maternal morbidity, as a composite outcome, posed challenges for clinical application. The 23-year study period may have inconsistencies in the coding of severe maternal morbidity.

DISCLOSURES:

The study was funded by the National Institutes of Health, National Institute of Nursing Research, and the Office of Research on Women’s Health. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.