///2017 Abstract Details
2017 Abstract Details2019-08-02T15:54:53-06:00

Cost-based Criticality of Chronic Maternal Comorbidities

Abstract Number: T-31
Abstract Type: Original Research

Jean Guglielminotti MD, PHD1 ; Jean Guglielminotti MD, PHD2; Ruth Landau MD3; Guohua Li MD, DrPH4


The increased prevalence of chronic comorbidities in pregnant women is a major driver for the increase in severe maternal morbidity observed in the United States during the last 2 decades.(1) Early interventions may help reduce severe maternal morbidity but require identifying modifiable risk factors. Criticality, defined as the product of the incidence and severity of a medical condition, is a novel tool that could be used to prioritize chronic comorbidities requiring interventions.(2) Severity can be estimated with the adjusted excess cost attributed to a given condition.(3) The purpose of this study was to assess and rank the cost-based criticality of chronic maternal comorbidities during labor and delivery in a nationally representative sample.


Hospital discharge records indicating labor and delivery, and 15 most commonly listed chronic maternal comorbidities were identified with ICD-9-CM codes in the National Inpatient Sample (NIS) 2012, a 20% representative sample of hospitalizations from community hospitals in the United States. The adjusted excess cost was calculated as the difference between the mean adjusted costs of discharges with and without the examined comorbidity.(3) Costs were calculated as the product of hospital charges and a cost-to-charge ratio provided by the NIS, and adjusted with a linear regression model. Confidence intervals (CI) were exact CI or bootstrap CI.


The study sample included 734,865 delivery-related discharges, or 19% of the live births reported in the United States in 2012. There was at least 1 chronic comorbidity recorded in 112,171 of the discharges (15.3%; 95% CI: 15.2-15.4). Obesity (criticality: $56.8) was the most highly ranked chronic comorbidity, followed by asthma ($24.2), psychiatric disorders ($17.0), and pre-existing diabetes mellitus ($13.5) (Table 1).


Obesity, asthma, psychiatric disorders, and pre-existing diabetes mellitus are the chronic comorbidities most critical to maternal outcomes. Effective interventions targeting these comorbidities should be incorporated into reproductive health programs and merit high priorities to improve maternal health.


(1) Obstet Gynecol 2012;120:1029-36

(2) Joint Commission Resources 2010

(3) Anesth Analg 2016;122: 2007-16

SOAP 2017