Severe maternal morbidity and risk of adverse pregnancy, delivery, and neonatal outcomes in the subsequent delivery
Bibliographic record
Abstract
BACKGROUND: Severe maternal morbidity is associated with substantially increased risks of adverse neonatal outcomes. However, few studies have assessed the association between severe maternal morbidity and adverse pregnancy, delivery, and perinatal outcomes in the subsequent delivery. OBJECTIVE: We aimed to investigate the association between severe maternal morbidity and its specific types in the first delivery and the risk of adverse pregnancy, delivery, and neonatal outcomes in the second delivery. STUDY DESIGN: We examined 2 population-based cohorts in Sweden and British Columbia, Canada, of mothers with both their first and second delivery recorded. The primary exposure was severe maternal morbidity in the first delivery (recorded during pregnancy, delivery or within 42 days postpartum). The outcomes were pregnancy and delivery complications, and offspring composite severe neonatal morbidity, and perinatal mortality (ie, stillbirths or neonatal deaths) within the first 28 days after birth, in the second delivery. We used multivariable generalized linear models to obtain adjusted risk ratios and 95% confidence intervals, adjusted for confounders. RESULTS: In both Sweden and British Columbia, women who experienced severe maternal morbidity in their first delivery had an increased risk of composite perinatal death/severe neonatal morbidity in the second delivery (Sweden: adjusted risk ratio, 1.88; 95% confidence interval, 1.75-2.02, British Columbia: adjusted risk ratio, 1.49; 95% confidence interval, 1.24-1.79), compared with mothers without severe maternal morbidity in the first delivery. In Sweden, second deliveries to women who had severe maternal morbidity in their first delivery were associated with a 1.59-times higher risk of stillbirth, a 1.65-times higher risk of neonatal mortality, a 1.95-times higher risk of composite severe neonatal morbidity, and 1.69-fold higher risk of infant mortality. In Sweden, compared with unaffected first delivery, severe maternal morbidity in the first delivery was associated with a 4.77-fold higher risk of severe maternal morbidity, 6.20-fold higher risk of preeclampsia, and an approximately 2-fold increased risk of placental abruption, maternal infection, antepartum hemorrhage, and postpartum hemorrhage in the second delivery. While in British Columbia, the adjusted estimates were in the same direction as in Sweden, statistical significance was reached for several outcomes, specifically, infant mortality, severe maternal morbidity, preeclampsia, gestational diabetes, placental abruption, antepartum hemorrhage, postpartum hemorrhage, and both elective and cesarean delivery in the second delivery. CONCLUSION: In both Sweden and British Columbia, Canada, severe maternal morbidity in the first delivery was associated with an increased risk of adverse pregnancy, delivery, and offspring outcomes in the subsequent delivery. Our findings can guide clinical and reproductive counseling for women with a history of severe maternal morbidity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".