Severe Maternal Morbidity and 30-Day Postpartum Readmission in the Military Health System

Background: The Centers for Disease Control and Prevention (CDC) cite an increase of 200% in severe maternal morbidity (SMM) in the United States from 1993 to 2014. This study aims to identify the incidence of SMM in the Military Health System (MHS), along with factors that may be correlated with the risk of SMM and 30-day readmissions among universally insured, ethnically diverse women who delivered in military treatment facilities (MTFs). Methods: Using the MHS Data Repository, we conducted a cross-sectional study on all women 15 to 54 years of age who delivered at a MTF during fiscal years 2016 to 2018. Using the CDC's list of 21 indicators and corresponding International Classification of Diseases diagnostic and procedure codes, 10th revision (ICD-10) for SMM, hospitalizations with SMM were identified within our selected group at the time of the delivery, as well as the prevalence of overall 30-day maternal readmissions. Multivariable logistic regressions were conducted to determine the likelihood of SMM and 30-day readmissions, with patient demographics at each delivery as predictor variables. Results: Of the total deliveries, 2.58% had maternal readmissions within 30 days and 0.59% had SMM identified. Women 35-39 years of age and ages 40+ had significantly higher odds of SMM during delivery when compared with women 25-29 years of age. Black women were 1.39 times more likely than White women to be diagnosed with SMM during their delivery admission. Black women also had significantly greater odds of a 30-day postpartum readmission when compared with White women. Conclusions: The low rate of SMM in this population, compared with national data, is a significant finding. The overall 30-day readmission rate in this population is also lower than what has been reported in prior studies. In this study population, women 30-34 are also at higher risk for readmission, which is an area for further study to assess for potential risk factors and underlying causes that may be impacting the higher rates in this age group.