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Obstetric Quality and Safety

Poster Session 3

(707) Patient factors associated with severe maternal morbidity by urban-rural designation in Georgia, United States

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Georgia has among the highest rates of severe maternal morbidity (SMM) in the nation. Location of residence has been identified as a contributing factor for SMM, with those in metropolitan and rural Georgia at highest risk. To determine whether SMM risk factors differed by location of residence, we evaluated the association of maternal and pregnancy characteristics with SMM stratified by categories of urban-rural designation.

Study Design: This population cohort study included all delivery hospitalizations in Georgia during 2016-2020 with birth record linked to hospital discharge data (n = 529,357). Multivariable robust Poisson regression analysis was used to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI) for the association of maternal and pregnancy characteristics with SMM at delivery admission or through 42 days postpartum, stratified by location of residence (categorized using the National Center for Health Statistics Urban-Rural Classification Scheme for Counties). SMM was identified using the 21 indicators defined by the Centers for Disease Control.

Results:

Across all residency categories, cesarean delivery was the factor most strongly associated with SMM (aRR 3.52, 95% CI 3.04-4.06 in small metro). Association of comorbidities varied by residency location. In metropolitan Georgia, severe mental illness (aRR 1.56, 95% CI 1.43-1.70), hypertension (aRR 1.40, 95% CI 1.28-1.53), and substance use (aRR 1.26, 95% CI 1.09-1.46) were the comorbidities most strongly associated. In rural Georgia, severe mental illness (aRR 1.40; 95% CI 1.05-1.86) and hypertension (aRR 1.39, 95% CI 1.08-1.80) were most strongly associated. The strength of association between hypertensive disorders of pregnancy and SMM increased as rurality increased (aRR 1.08, 95% CI 1.96-2.21 in metropolitan vs. aRR 2.53, 95% CI 2.01-2.13 in rural).

Conclusion: These findings demonstrate variation in factors associated with SMM by location of residence in Georgia and underscore the need for tailored prevention efforts within each location of residence.