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Poster Session 2

Category: Obstetric Quality and Safety

Poster Session 2

(612) Triple threat: how obesity, chronic hypertension, and pregestational diabetes drive severe maternal morbidity

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Nida Ali, BS (she/her/hers)

Clinical Research Coordinator III
Loma Linda University Children's Health | Perinatal Institute
Loma Linda, California, United States

Coauthor(s)

BP

Bo Park, MPH, PhD

Associate Professor
California State University, Fullerton
Fullerton, California, United States
Ashra Tugung, CCRP

Clinical Research Coordinator
Loma Linda University Children's Health | Perinatal Institute
Loma Linda, California, United States
Sergio A. Karageuzian, DO

PGY-2 Resident
Loma Linda University Health
Loma Linda, California, United States
HR

Havilah Reimche-Vu, BS

Medical Student
Loma Linda University School of Medicine
Loma Linda, California, United States
Kriti N. Vedhanayagam, DO

PGY-3 Resident
Loma Linda University
Loma Linda, California, United States
Ilish Gedestad, DO

PGY-1 Resident
Loma Linda University Health
Loma Linda, California, United States
NT

Neville Tritch, BS

Medical Student
Loma Linda University School of Medicine
Loma Linda, California, United States
KH

Kevin H. Hu, MD

Loma Linda University
Loma Linda, California, United States
Ruofan H. Yao, MD, MPH

Maternal Fetal Medicine Faculty
Loma Linda University
Loma Linda, California, United States

Objective:
To examine whether obesity, chronic hypertension (HTN), and pregestational diabetes (DM), independently and through interactive effects, are associated with risk of severe maternal morbidity (SMM).

Study Design:
We conducted a population-based, retrospective cohort study using the California Office of Statewide Health Planning and Development Linked Birth File with ICD-9-CM diagnoses from 2007–2012. Patients were grouped by the presence of obesity, HTN, and DM independently and interactively. Chi-square tests determined associations with SMM, and cox proportional hazard analysis estimated SMM risk for each condition and their interactions, adjusting for maternal age, parity, prior cesareans, delivery year, and mode of delivery. A cumulative hazard graph illustrated gestational age at SMM occurrence. Hazard ratios (HRs) with 95% confidence intervals (CIs) were reported to indicate the magnitude and reliability of risks.

Results:
Among 2.9 million deliveries, SMM incidence was 1.47% in women without these conditions. Obesity alone (n=817,034) was not associated with increased risk (HR 0.97 [95% CI: 0.97–1.01]). HTN only (n=6,128) (HR 6.47 [95% CI: 5.85–7.15]) and DM only (n=9,961) (HR 2.36 [95% CI: 2.11–2.64]) were strong independent risk factors. When obesity interacted with HTN or DM, HRs were elevated but lower than HTN or DM alone: obesity+HTN (n=7,648; HR 4.61 [95% CI: 4.16–5.10]) and obesity+DM (n=13,764; HR 1.97 [95% CI: 1.79–2.18]). HTN+DM (n=421) demonstrated the highest risk with an 11-fold increase (HR 11.02 [95% CI: 8.08–15.02]), while the triple combination (n=1,021) also markedly increased risk (HR 5.86 [95% CI: 4.59–7.48]).

Conclusion:
Chronic HTN, especially when interacting with obesity or pregestational DM, greatly increases SMM risk, underscoring the need for targeted prenatal care. Obesity alone conferred a slightly lower risk.