(1277) Risk Factors for Preventable Severe Early Pregnancy Morbidity at a Tertiary Academic Center

To characterize risk factors for preventable severe early pregnancy morbidity (SEPM) events in pregnancies < 24 weeks.

Study Design:

This was a retrospective cohort study evaluating SEPM < 24 weeks from 1/2017 to 12/2023 at a tertiary academic center. We defined SEPM by one or more of the following criteria: (1) CDC-defined severe maternal morbidity (SMM) diagnosis codes; (2) transfusion of >4 units of blood or ICU-admission; or (3) or abortion-related morbidity, including pelvic infection, damage to pelvic organs, or hemorrhage. We included patients aged 12-55 years with hospital encounters occurring at < 24 0/7 weeks or ≤ 42 days following the end of a pregnancy ending < 24 weeks. We identified possible SEPM events using ICD-10 codes, blood product administration records, and intensive care transfer records, and confirmed presence of true SEPM events by medical record review. We assessed preventability using the Alliance for Innovation of Maternal Health SMM review form. We conducted univariate and multivariate logistic regression analysis to estimate independent risk factors for development of a preventable SEPM compared to non-preventable SEPM. Covariates included age, obesity, race, ethnicity, any maternal comorbidity, insurance status, area deprivation index, and maternal transport from outside facility. We calculated unadjusted (OR) and adjusted odds ratios (aOR) and 95% confidence intervals (CIs).

Results:

Of 46,181 unique pregnancies, 407 SEPM events were identified (0.88% of all pregnancies). SEPM events were deemed preventable in 126/407 (31%) of events. In a multivariable model, age 24–35 (aOR 2.53, 95% CI 1.01–6.35) and > 35 (aOR 3.30, 95% CI 1.24–8.77) and maternal transport (aOR 2.67, 95% CI 1.50–4.76) were associated with higher odds of preventability. Obesity was associated with lower odds of preventability (aOR 0.54, 95% CI 0.31–0.95) (Table 1).

Conclusion:

Older age and maternal transport were associated with higher odds of preventability, while BMI was associated with lower odds. Identifying risk factors for preventability may help target interventions to reduce preventable SEPM.