IMI Blog


Increased number of comorbidities associated with higher likelihood of severe maternal morbidity

Caroline E. Adams & Clare C. Brown, PhD, MPH

October 22, 2020


IMI’s latest research article, released ahead-of-print in the journal Obstetrics and Gynecology, examines risk of severe maternal morbidity in association with chronic conditions and maternal race/ethnicity. An analysis was performed using a nationally representative sample of delivery hospitalizations. Medicaid covers almost half of all births in the United States and a high proportion of Black and Hispanic pregnant individuals. Furthermore, women of lower income are at higher risk of having more chronic conditions. Therefore, the results have important implications for the Medicaid program which acts as an important safety net for low income women. The findings add to a growing body of research, highlighting that reductions in comorbid conditions may reduce rates of maternal morbidity overall.

Severe maternal morbidity refers to inadvertent consequences of labor and delivery that significantly impact the health of birthing people. Previous research has demonstrated that the risk of severe maternal morbidity is increased for individuals who have multiple chronic conditions. Furthermore, racial inequities exist in prevalence of chronic conditions during pregnancy with Black individuals being almost twice as likely to have a comorbid condition than white, contributing to racial inequity in maternal morbidity.

The study found that as the number of comorbidities increased, the rate of severe maternal morbidity increased proportionately. The highest rate of severe maternal morbidity was seen among women who had three or more comorbid conditions. In addition, of note, Black women were less likely to have zero comorbidities compared to White, Hispanic, and Asian women.

The findings emphasize the need for better prevention and treatment of chronic conditions for women, and specifically for Black women. Chronic conditions can develop before and persist after childbearing age, highlighting the importance of whole person care across the lifespan for effective prevention and treatment. The cumulative impact of discrimination and bias experienced across a lifetime as a result of racism may also contribute to higher rates of chronic conditions and severe maternal morbidity among Black women. Efforts to reduce chronic condition prevalence as well as address structural and interpersonal racism outside of the health care system may be integral to reducing racial inequity in maternal morbidity and other maternal health outcomes. The authors hope that the results inform future research, policy, and clinical care efforts to reduce maternal morbidity and improve health equity.