{ "abstract": "Background\n\nPreterm birth is associated with an increased rate of serious maternal complication compared with those who deliver at term. However, data are limited on risk factors for maternal morbidity and mortality specifically in the setting of preterm birth. Improved understanding of risk factors for morbidity in patients with preterm birth can help optimize interventions to best support patients experiencing preterm birth.Objective\n\nTo assess associations between obstetric factors and maternal morbidities and mortality among patients who gave birth less than 35 weeks' gestation.Study design\n\nThis is a secondary analysis of a multicenter registry of gravidas carrying singletons or twins who gave birth at 16 0/7 to 34 6/7 weeks' gestation January through August 2019. The primary outcome was a maternal morbidity and mortality composite (blood transfusion, postpartum hemorrhage, maternal sepsis, stroke, thromboembolism, intensive care unit admission, or death) during the delivery hospitalization. Factors were compared between those with and without the composite outcome to identify statistically significant variables. Those factors were then used to create a parsimonious multivariable logistic regression model with adjusted odds ratio (aOR) and 95% confidence intervals (CIs) using a backward strategy. We estimated area under the curve to quantify the predictive ability of these factors for the primary outcome.Results\n\nThe analysis was based on 6660 patients, of whom 15.1% experienced the primary composite outcome. Factors associated with increased odds of the outcome included increasing maternal age, use of assisted reproductive technology, twin gestation, preeclampsia, placental abruption and cesarean delivery-aOR ranged from 1.02 [1.01-1.04] for maternal age (continuous) to 2.55 [2.08-3.14] for abruption. In contrast, nulliparity, gestational diabetes, preterm prelabor rupture of membranes (PPROM), and later birth gestational age were associated with decreased odds of the primary outcome-aOR ranging from 0.96 [0.95-0.98] for gestational age (continuous) to 0.54 [0.44-0.66] for PPROM. The model with these factors had low to moderate predictive ability (AUC 0.68 [0.66-0.69]).Conclusion\n\nAmong individuals who experienced preterm birth before 35 weeks, multiple factors were associated with maternal morbidity and mortality. The factors together modestly discriminate maternal morbidity or mortality.", "abstract_shown": true, "affiliations": [ "Department of Obstetrics and Gynecology, University of Alabama at Birmingham Birmingham Alabama USA.", "The George Washington University Biostatistics Center Washington District of Columbia USA.", "Department of Obstetrics, Gynecology, and Reproductive Sciences University of Texas Health Science Center at Houston Houston Texas USA.", "Department of Obstetrics and Gynecology The Ohio State University Columbus Ohio USA.", "Department of Obstetrics and Gynecology University of Utah Health Sciences Center Salt Lake City Utah USA.", "Eunice Kennedy Shriver National Institute of Child Health and Human Development Bethesda Maryland USA.", "Department of Obstetrics and Gynecology University of Iowa Iowa City Iowa USA.", "Department of Gynecology and Obstetrics Emory University School of Medicine and Children's Healthcare of Atlanta Atlanta Georgia USA.", "Department of Obstetrics and Gynecology Brown University Providence Rhode Island USA.", "Department of Obstetrics and Gynecology University of Texas Medical Branch Galveston Texas USA.", "Department of Obstetrics and Gynecology University of North Carolina at Chapel Hill Chapel Hill North Carolina USA.", "Department of Obstetrics and Gynecology Columbia University New York New York USA.", "Department of Obstetrics and Gynecology Northwestern University Chicago Illinois USA.", "Department of Obstetrics and Gynecology University of Pittsburgh Pittsburgh Pennsylvania USA.", "Department of Obstetrics and Gynecology Case Western Reserve University Cleveland Ohio USA.", "Department of Obstetrics and Gynecology University of Pennsylvania Philadelphia Pennsylvania USA.", "Department of Women's Health University of Texas at Austin Austin Texas USA." ], "article_type": "research article", "arxiv": null, "author_total": 22, "authors": [ { "affs": [ 0 ], "name": "Marcia K Des Jardin", "orcid": "0009-0001-8000-6298" }, { "affs": [ 1 ], "name": "Paula L McGee" }, { "affs": [ 2 ], "name": "Baha M Sibai", "orcid": "0000-0001-9982-7873" }, { "affs": [ 1 ], "name": "Rebecca G Clifton", "orcid": "0000-0001-7821-2861" }, { "affs": [ 3 ], "name": "Maged M Costantine", "orcid": "0000-0003-4076-469X" }, { "affs": [ 4 ], "name": "Michael W Varner", "orcid": "0000-0001-9455-3973" }, { "affs": [ 5 ], "name": "Monica Longo", "orcid": "0009-0005-4200-1671" }, { "affs": [ 6 ], "name": "Edward F Bell", "orcid": "0000-0002-5568-0889" }, { "affs": [ 7 ], "name": "Barbara J Stoll" }, { "affs": [ 8 ], "name": "Donna Allard" }, { "affs": [ 9 ], "name": "Ashley Salazar" }, { "affs": [ 10 ], "name": "John M Thorp" }, { "affs": [ 11 ], "name": "Uma M Reddy" }, { "affs": [ 12 ], "name": "Emily S Miller", "orcid": "0000-0001-9927-1043" }, { "affs": [ 8 ], "name": "Dwight J Rouse" }, { "affs": [ 13 ], "name": "Hyagriv N Simhan" }, { "affs": [ 0 ], "name": "Alan T N Tita" }, { "affs": [ 14 ], "name": "Jennifer L Bailit", "orcid": "0009-0000-1489-9190" }, { "affs": [ 15 ], "name": "Lorraine Dugoff", "orcid": "0000-0003-3638-036X" }, { "affs": [ 16 ], "name": "George A Macones" }, { "affs": [ 9 ], "name": "George R Saade" }, { "name": "Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal‐Fetal Medicine Units (MFMU) Network" } ], "bibtex": "https://research.draconitic.com/paper/bjmcrrwbmf4cb.bib", "cited_by": 0, "doi": "10.1002/pmf2.70497", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13752639/?tool=EBI", "id": "bjmcrrwbmf4cb", "issns": [ "2997-9684" ], "landing_url": "https://europepmc.org/article/PMC/PMC13752639", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Original Research" ], [ "openalex", "2729|Preterm Birth and Chorioamnionitis" ] ], "openalex": "W7225771906", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13752639/pdf/?tool=EBI", "pmcid": "PMC13752639", "pmid": "43017384", "published": "2026-11-01", "publisher": "Wiley", "ris": "https://research.draconitic.com/paper/bjmcrrwbmf4cb.ris", "sources": [ { "first_seen": "2026-11-12T15:23:18Z", "native_id": "PMC:PMC13752639", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13752639" }, { "first_seen": "2026-11-14T15:20:45Z", "native_id": "MED:43017384", "source": "europepmc", "url": "https://europepmc.org/article/MED/43017384" }, { "first_seen": "2026-11-15T12:22:00Z", "native_id": "PMC13752639", "source": "pmc", "url": "https://doi.org/10.1002/pmf2.70497" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2729|Preterm Birth and Chorioamnionitis", "subfield": "reproductive-child" } ], "title": "Association of obstetric factors with maternal morbidity and mortality in patients who gave birth preterm", "title_text": "Association of obstetric factors with maternal morbidity and mortality in patients who gave birth preterm", "type": "peer-reviewed", "updated_at": "2026-11-15T12:22:00Z", "url": "https://research.draconitic.com/paper/bjmcrrwbmf4cb", "venue": "Pregnancy (Hoboken, N.J.)", "versions": [] }