ArticleBMJ public health2026
Severe maternal morbidity and re-hospitalisation in the first postpartum year within Canada, 2008-2020: a population-based retrospective cohort study.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Severe maternal morbidity (SMM) refers to life-threatening pregnancy-related complications that may have lasting effects on the mother beyond childbirth. Little is known about the impact of SMM on re-hospitalisations in the first year following birth hospitalisation discharge. In this study, we quantified the 1-year risk of maternal re-hospitalisation following birth discharge, comparing SMM-affected to SMM-unaffected individuals. Methods: We conducted a population-based cohort study using hospitalisation data for all live births and stillbirths in Canada, excluding Québec, between 2008 and 2020 to individuals aged 16-55 years. SMM was assessed using a validated measure based on diagnostic and procedure codes for a composite of life-threatening diagnoses during pregnancy beginning at 20 weeks' gestation, during childbirth, or within 42 days following birth hospitalisation discharge. Outcomes were all-cause re-hospitalisation within 42 days of birth hospitalisation discharge and from 43 to 365 days following birth hospitalisation discharge. Log-binomial regression with generalised estimating equations generated unadjusted and adjusted risk ratios (aRRs). We then described causes of re-hospitalisation according to International Classification of Diseases, 10th Revision, Canadian Enhancement chapters, based on the first diagnostic field. Results: There were 3 405 716 births in the study, (mean maternal age 30.0 + 5.5 years and 40% nulliparous), among which 60 260 (1.83%) experienced SMM. Individuals with versus without SMM were more likely to be re-hospitalised within 42 days, with respective rates of 14.6 vs 4.4 per 1000 births (aRR 2.90, 95% CI 2.68 to 3.13). For re-hospitalisation at 43-365 days, respective rates were 62.4 and 29.8 per 1000 births (aRR 1.90, 95% CI 1.84 to 1.96). The most frequent cause of re-hospitalisation in both groups was gallstone disease. Conclusions: Individuals who experience SMM are more likely to be re-hospitalised in the first year following birth hospitalisation discharge, highlighting the need for tailored postpartum care to prevent re-hospitalisation.
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