(495) Evaluating Concordance Between Patient Perceptions of Risk for Maternal Morbidity and Established Risk Factors

Perception of risk is an important driver of health behaviors and engagement in care. It is unknown whether pregnant patients accurately recognize risk level for severe maternal morbidity (SMM). This study investigates patient evaluations of SMM risk compared to established criteria for assessing maternal risk.

Study Design:

This mixed methods study was designed to evaluate postpartum patients’ experiences and perceptions related to SMM. Qualitative data from structured patient interviews were used to develop a survey assessing patient understanding of their own risk in pregnancy (domains in Table). Responses were collected on Likert scales and as rankings of pregnancy co-morbidities in terms of perceived risk level (scale of 0=“no increased risk”-5=“high risk”). Perceptions of personal risk and risk ratings of each condition were compared by patient obstetric co-morbidity index (OB-CMI) [low = < 6 vs high = > 6] derived from chart review.

Results:

501 patients participated in the study 6-11/2022 (60.7% Black, 6.5% Hispanic). Median OB-CMI score was 1 (IQR 0-3) [11.6% with high OB-CMI > 6]. Patients with high OB-CMI perceived increased personal risk in all domains but reported similar ability to control risk as patients with low OB-CMI (Table). When ranking antenatal conditions by risk level, patients with high OB-CMI ranked preeclampsia and hypertension higher than those with low OB-CMI (mean 4.2 [SD 1.6] vs 3.5 [2.0]; p =0.01; 3.8 [1.9] vs 3.2 [2.1], p=0.03), with no other significant differences. Of all OB-CMI components, both groups rated preeclampsia highest and asthma lowest.

Conclusion:

Patients with established risk factors for SMM accurately perceived themselves at higher risk. They also better appreciated risks associated with hypertension/preeclampsia. These data suggest that current frameworks for conveying risk to obstetric patients are effective, but may be enhanced by increased focus on strategies to increase patient agency to modify risk.