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Q&A

Obstetric Quality and Safety

Poster Session 3

(668) Validation of an extended maternal comorbidity index (MCI) for prediction of severe maternal morbidity

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: The expanded maternal comorbidity index (MCI) developed by Leonard et al uses pre-existing maternal health conditions (e.g., hypertension, asthma, etc.) to produce a risk score that predicts severe maternal morbidity (SMM). This tool has been adopted into clinical and research use without external validation in a data source not reliant on administrative codes. We assessed the validity of the MCI to predict SMM in a modern obstetric cohort with detailed medical record abstraction.

Study Design: Secondary analysis of a multicenter cohort of patients delivering on randomly selected days at 17 U.S. hospitals from 2019 through 2020. Data were manually abstracted from the medical record by trained staff. The MCI risk score was applied to all individuals within the cohort. The primary outcome was SMM as defined by the Centers for Disease Control and Prevention (CDC-SMM). Secondary outcomes included SMM without blood transfusion and the ACOG/SMFM definition of SMM (i.e., transfusion of ≥4 units of blood or intensive care unit admission). The median MCI score was calculated for the cohort, and the performance of the MCI risk score to predict SMM was assessed using the area under the receiver operating curve (AUC).

Results:

Of 20,898 eligible patients, 668 (3.2%, 95% CI 3.0-3.4%) experienced CDC-SMM, 184 (0.9%, 95% CI 0.8-1.0%) experienced CDC-SMM without transfusion, and 142 (0.7%, 95% CI 0.6-0.8%) experienced ACOG/SMFM-SMM. In this cohort, the most common comorbidities were anemia (22.7%), maternal age at least 35 years (22.2%), and previous cesarean delivery (18.4%). The median MCI score in the cohort was 57.5 (IQR 47.5-71.5), which corresponded to a SMM risk of 7.9% (IQR 5.3-13.5%). The AUC for the MCI to predict CDC-SMM was 0.72 (95% CI 0.70-0.74; compared to AUC 0.78 in Leonard et al), CDC-SMM without transfusion was 0.83 (95% CI 0.79-0.86) and ACOG/SMFM-SMM was 0.79 (95% CI 0.75-0.83; Figure).

Conclusion: We externally validated the expanded MCI for prediction of SMM in a contemporary obstetric cohort. These findings support the ongoing use of this tool in research and clinical settings.