Risk of Recurrent Severe Maternal Morbidity: A Population-Based Study

( Am J Obstet Gynecol . 2023;229(5):545.e1–545.e11. doi: 10.1016/j.ajog.2023.06.010) The occurrence of severe maternal morbidity (SMM), a composite indicator of maternal wellness and care in pregnancy or up to 42 days following delivery, is increasing. SMM precedes over half of maternal deaths, is associated with extended hospital stays, and linked to long-term cardiovascular health concerns. Public health agencies prioritize monitoring SMM to drive better clinical care and outcomes. Understanding SMM recurrence is crucial for informed decision-making and complex care planning during subsequent pregnancies. Recent epidemiologic studies, several limited to privately insured populations, have found a 3 to 8 folds increased relative risk of SMM recurrence. However, diverse populations and individual SMM criteria have not been studied. This study aimed to understand SMM recurrence risk in a second pregnancy in patients with a history of SMM as a primary composite outcome and by disease-specific conditions secondarily, adjusting for known factors like age, health conditions, substance use, and socioeconomic status.