OBJECTIVES

The rate of maternal mortality has been increasing in Texas since 2010 resulting in a need to understand its cause. Severe maternal morbidity (SMM) refers to undesirable outcomes during labor and delivery that can affect a woman’s health or lead to maternal death. Therefore, the objectives of this study are to examine the trend of SMM in Texas from 2008 through 2015 and to determine the demographic and clinical factors related to increased risk of SMM among Texas women of reproductive age.

METHODS :

About 3 million deliveries in Texas between 2008-2015 were identified in inpatient discharge files from the Texas Department of Health and Human Services. Approximately 56,000 of these deliveries experienced an SMM condition identified by ICD and procedure codes. The study assessed the trend of SMM rates in Texas and performed multivariate logistic regression analysis to identify risk factors (e.g., age, payer type, race/ethnicity, the presence of other chronic conditions, residential location) that were associated with a higher likelihood of SMM events.

RESULTS

The SMM rate for Texas increased by 15% from 2008 (171.4 /10,000 deliveries) to 2015 (197.4/10,000 deliveries). Teenagers, women over the age of 40, black women, and women with multiple comorbidities (e.g., hypertension, diabetes, and depression) were more likely to experience an SMM condition during their delivery. Women with cesarean births and deliveries covered by Medicaid were also associated with a higher likelihood of an SMM event.

CONCLUSIONS

SMM rates in Texas have increased over recent years with multiple factors are contributing to it. There is a great need for longitudinal data-driven analysis to better understand barriers to accessing prenatal and postnatal care and to allow the design of effective interventions for reducing SMM risk among women in Texas.