Researchers wanted to investigate the long-term risks of death following a pregnancy complicated by significant maternal morbidity. Researchers examined a longitudinal cohort of 1,229,306 women who gave birth in the Canadian province of Quebec between 1989 and 2016. Cerebrovascular accidents, acute renal failure, severe preeclampsia, and other life-threatening consequences were severe maternal morbidities. The outcome was in-hospital mortality following the previous pregnancy, classified as postpartum (42 days or less after birth) or long-term (43 days to 29 years after delivery). Using Cox regression models adjusted for maternal variables, they calculated hazard ratios (HRs) of death with 95% confidence intervals for severe maternal morbidity vs no severe morbidity.
Maternal morbidity was severe in 2.9% of the mothers. The death rate linked with significant maternal morbidity was 0.86 per 1,000 person-years, compared to 0.41 per 1,000 person-years when no morbidity was present. Severe maternal morbidity was related with double the incidence of mortality any time after birth (95% CI 1.81–2.20) compared to no morbidity. The major morbidities linked with death after 42 days were severe cardiac problems (HR 7.00, 85% CI 4.94–9.91), acute renal failure (HR 4.35, 95% CI 2.66–7.10), and cerebrovascular accidents (HR 4.03, 95% CI 2.17–7.48).
Women who have severe maternal morbidity have a higher risk of death after the postpartum period than women who do not have severe morbidity. Women who have major pregnancy problems may benefit from more thorough clinical follow-up.
