Association of obstetric factors with maternal morbidity and mortality in patients who gave birth preterm
17 affiliations
- 1Department of Obstetrics and Gynecology, University of Alabama at Birmingham Birmingham Alabama USA.
- 2The George Washington University Biostatistics Center Washington District of Columbia USA.
- 3Department of Obstetrics, Gynecology, and Reproductive Sciences University of Texas Health Science Center at Houston Houston Texas USA.
- 4Department of Obstetrics and Gynecology The Ohio State University Columbus Ohio USA.
- 5Department of Obstetrics and Gynecology University of Utah Health Sciences Center Salt Lake City Utah USA.
- 6Eunice Kennedy Shriver National Institute of Child Health and Human Development Bethesda Maryland USA.
- 7Department of Obstetrics and Gynecology University of Iowa Iowa City Iowa USA.
- 8Department of Gynecology and Obstetrics Emory University School of Medicine and Children's Healthcare of Atlanta Atlanta Georgia USA.
- 9Department of Obstetrics and Gynecology Brown University Providence Rhode Island USA.
- 10Department of Obstetrics and Gynecology University of Texas Medical Branch Galveston Texas USA.
- 11Department of Obstetrics and Gynecology University of North Carolina at Chapel Hill Chapel Hill North Carolina USA.
- 12Department of Obstetrics and Gynecology Columbia University New York New York USA.
- 13Department of Obstetrics and Gynecology Northwestern University Chicago Illinois USA.
- 14Department of Obstetrics and Gynecology University of Pittsburgh Pittsburgh Pennsylvania USA.
- 15Department of Obstetrics and Gynecology Case Western Reserve University Cleveland Ohio USA.
- 16Department of Obstetrics and Gynecology University of Pennsylvania Philadelphia Pennsylvania USA.
- 17Department of Women's Health University of Texas at Austin Austin Texas USA.
Abstract
Background
Preterm 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
To assess associations between obstetric factors and maternal morbidities and mortality among patients who gave birth less than 35 weeks' gestation.Study design
This 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
The 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
Among 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.
Related
- Maternal and Peri/Neonatal Mortality and Morbidity in Midwife‐Assisted Low‐Risk Birth Outside Hospital Compared to Obstetric Team‐Assisted Low‐Risk Hospital Birth: A Systematic Review and Meta‐Analysis
- Discriminatory power of organ-specific Sequential Organ Failure Assessment (SOFA) scores: Predictors of maternal mortality in obstetric intensive care units (ICU)
- Admission Rate, Indications, Maternal Outcomes, and Factors Associated with Mortality Among Obstetric Intensive Care Unit Admissions at a Tertiary Referral Hospital in Tanzania.
- Association of brain glymphatic system with risk of incident mortality and morbidity.
- Documented Obstetric Haemorrhage in a General Intensive Care Unit in Ghana: Outcomes and the Unadjusted Association Between Recorded GCS and Mortality
BibTeX
@article{jardin2026association,
title = {{Association of obstetric factors with maternal morbidity and mortality in patients who gave birth preterm}},
author = {Marcia K Des Jardin and Paula L McGee and Baha M Sibai and Rebecca G Clifton and Maged M Costantine and Michael W Varner and Monica Longo and Edward F Bell and Barbara J Stoll and Donna Allard and Ashley Salazar and John M Thorp and Uma M Reddy and Emily S Miller and Dwight J Rouse and Hyagriv N Simhan and Alan T N Tita and Jennifer L Bailit and Lorraine Dugoff and George A Macones and George R Saade and Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal‐Fetal Medicine Units (MFMU) Network},
journal = {Pregnancy (Hoboken, N.J.)},
year = {2026},
month = nov,
doi = {10.1002/pmf2.70497},
url = {https://europepmc.org/article/PMC/PMC13752639},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association of obstetric factors with maternal morbidity and mortality in patients who gave birth preterm
AU - Marcia K Des Jardin
AU - Paula L McGee
AU - Baha M Sibai
AU - Rebecca G Clifton
AU - Maged M Costantine
AU - Michael W Varner
AU - Monica Longo
AU - Edward F Bell
AU - Barbara J Stoll
AU - Donna Allard
AU - Ashley Salazar
AU - John M Thorp
AU - Uma M Reddy
AU - Emily S Miller
AU - Dwight J Rouse
AU - Hyagriv N Simhan
AU - Alan T N Tita
AU - Jennifer L Bailit
AU - Lorraine Dugoff
AU - George A Macones
AU - George R Saade
AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal‐Fetal Medicine Units (MFMU) Network
PY - 2026
DA - 2026/11/01
JO - Pregnancy (Hoboken, N.J.)
DO - 10.1002/pmf2.70497
UR - https://europepmc.org/article/PMC/PMC13752639
AB - Background Preterm 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 To assess associations between obstetric factors and maternal morbidities and mortality among patients who gave birth less than 35 weeks' gestation.Study design This 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 The 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 Among 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.
SN - 2997-9684
ER -