# Presentation: 501759

## Maternal Morbidity in American Indian and Alaska Native Women, 2002-2004

**Methods**

- _Definitions_
- Delivery hospitalizations
- ICD-9 V27 code listed in any of the 15 diagnosis fields
- N=6761
- Maternal morbidity
- Selected ICD-9 pregnancy codes (640-677) listed in any of the 15 diagnosis fields
- Related ICD-9 codes outside of the 640-677 range
- _Analysis_
- Prevalence rates and 95% CI were calculated using     SAS 8.2

**Background**

**Conclusion**

**Table II. Demographic characteristics of American Indian and Alaska Native women, National Patient Information Reporting System, 2002-2004**

**Table III. Prevalence rates of selected maternal morbidity in American Indian and Alaska Native women, National Patient Information Reporting System, 2002-2004**

**Table IV. Mean length of delivery hospitalization among American Indian and Alaska Native women, National Patient Information Reporting System, 2002-2004**

**Public Health Impact**

- Stephen J. Bacak, MPH
- Division of Reproductive Health
- Centers for Disease Control and Prevention
- 4770 Buford Highway, NE, Mailstop K-23
- Atlanta, GA 30341
- Ph: 770-488-6271
- Email: sbacak@cdc.gov

**Contact Info**

- Maternal morbidity is a significant public health and economic burden in the United States
- There is little published information on maternal morbidity among American Indian and Alaska Native (AI/AN) women
- Some evidence suggests that AI/AN women have higher rates of morbidity compared to other race groups, including pregnancy-related hypertension, hemorrhage, and gestational diabetes

- National Patient Information Reporting System
- July 2002- June 2004
- International Classification of Disease, 9th Revision (ICD-9) codes

- Cesarean section rates in this population were lower than the general US population
- Midwives play a significant role in AI/AN pregnancies
- Compared to women in the US, AI/AN women are at an increased risk for some complications during delivery hospitalizations, particularly postpartum hemorrhage, gestational diabetes, and all preeclampsia
- In general, infection rates among AI/AN women are similar to women in the general US population

- Our findings stress the importance of comprehensive preconception and prenatal care in AI/AN women to prevent maternal morbidity and improve maternal health
- There is a need for continual surveillance and etiologic research to further understand the elevated health risk among AI/AN women
- Local and regional use of data should be used to inform policy and intervention strategies to improve access to care and public health messages regarding maternal morbidity

**Maternal Morbidity in American Indian and Alaska Native Women, 2002-2004**
**Stephen J. Bacak****1****, Judith Thierry****2****, Myra Tucker****1****, Edna Paisano****3**
- 1Division of Reproductive Health, Centers for Disease Control and Prevention, 2Office of Clinical and Preventive Services,
- 3Office of Public Health Planning and Support, Indian Health Service

| Maternal Morbidity | ICD-9 Codes |
| --- | --- |
| Antenatal hemorrhage*  | All 641 |
| Postpartum hemorrhage | All 666 |
| All preeclampsia/ eclampsia  | 642.4,  642.5, 642.6, 642.7, 642.9 |
|    Preeclampsia | 642.4 |
|    Severe preeclampsia/
   eclampsia | 642.5, 642.6 |
|    Transient hypertension | 642.3 |
| All Infections | All codes listed below |
|   Genitourinary | All 590, 599.0, 646.6 |
|   Amniotic | 658.4 |
|   Fever | 659.2 |
|   Other infections** | 041, 486, 615, 659.3, 670, 672, 682 |
| DVT/Obstetric embolism | 671.3, 671.4, All 673 |
| Gestational diabetes | 648.8 |
| *Includes placenta previa and placental abruption
**Includes Group B streptococcus, pneumonia, sepsis, and puerperal infections |  |

| Maternal Morbidity | Cesarean Delivery |  | Non-cesarean Delivery |  |
| --- | --- | --- | --- | --- |
|  | LOS* | 95% CI | LOS* | 95% CI |
| None | 2.9 | 2.8, 3.0  | 1.9 | 1.9, 2.0 |
| Antenatal hemorrhage | 4.1 | 2.9, 5.3 | 2.6 | 2.3, 2.9 |
| Postpartum hemorrhage | 3.5 | 3.3, 3.8 | 2.3 | 2.2, 2.4 |
| Preeclampsia | 5.4 | 3.9, 6.8 | 3.0 | 2.8, 3.2 |
| Severe preeclampsia/
   eclampsia | 4.8 | 4.0, 5.6 | 4.0 | 3.3, 4.7 |
| Transient hypertension | 3.9 | 3.3, 4.4 | 2.6 | 2.5, 2.8 |
| Genitourinary infection | 3.6 | 3.0, 4.1 | 2.4 | 2.2, 2.6 |
| Amniotic infection | 4.3 | 3.5, 5.0 | 2.9 | 2.4, 3.5 |
| Fever | 3.3 | 3.0, 3.7 | 2.5 | 2.3, 2.8 |
| Other infections | 5.6 | 4.7, 6.5 | 2.5 | 2.4, 2.7 |
| DVT/Obstetric embolism | ** | ** | ** | ** |
| Gestational diabetes | 3.6 | 3.3, 3.9 | 2.3 | 2.1, 2.4 |
| *Length of hospital stay
**Too small to report |  |  |  |  |

**Objectives**

- To determine the prevalence of selected maternal morbidities during delivery hospitalizations in AI/AN women

**Limitations**

- No information on important variables such as parity, obesity, urban/rural status, and health behaviors     (e.g. smoking, drinking)
- Unable to determine the week of prenatal care initiation and the number of antepartum visits
- Unable to link with infant hospitalizations to investigate neonatal outcomes (e.g. gestational age, APGAR scores)
- Morbidity data limited to ICD-9 codes

| Maternal Morbidity | % | 95% CI |
| --- | --- | --- |
| Antenatal hemorrhage  | 1.7 | 1.4, 2.0 |
| Postpartum hemorrhage | 8.5 | 7.8, 9.2 |
| All preeclampsia | 5.7 | 5.2, 6.3 |
|    Preeclampsia | 4.1 | 3.6, 4.6 |
|    Severe preeclampsia/
   eclampsia | 1.2 | 0.9, 1.4 |
|    Transient hypertension | 3.4 | 2.9, 3.8 |
| Infections |  |  |
|   Genitourinary | 2.5 | 2.2, 2.9 |
|   Amniotic | 1.5 | 1.2, 1.8 |
|   Fever | 1.2 | 0.9, 1.4 |
|   Other infections | 4.1 | 3.6, 4.6 |
| DVT/Obstetric embolism* | 0.1 | 0.02, 0.2 |
| Gestational diabetes | 7.6 | 6.9, 8.3 |
| Total | 29.1 | 27.8, 30.3 |
| *Should be considered unreliable due to small sample size |  |  |

| Characteristic | No. | % |  |
| --- | --- | --- | --- |
| Region
   Alaska
   East
   Southwest | 
1979
939
3843 | 
29.3
13.9
56.8 |  |
| Age (y)
    13-17
    18-24
    25-34
    35-45 | 
418
2921
2773
649 | 
6.2
43.2
41.0
9.6 |  |
| Length of hospital stay
   0-1
   2-3
   >4 | 
1504
4633
624 | 
22.3
68.5
9.2 |  |
| Cesarean delivery* | 1052 | 15.6 |  |
| Use of a midwife* | 5572 | 82.4
 |  |
| Eligible for Medicaid 
at visit* | 5274 | 78.0 |  |
| Eligible for private insurance at time of visit* | 2093 | 31.0 |  |
| *%Yes |  |  |  |

**Table I. ICD-9 morbidity codes, National Patient Information Reporting System, 2002-2004**