OBJECTIVE: To evaluate the associations between the number of chronic conditions and maternal race and ethnicity (race) with the risk of severe maternal morbidity. METHODS: Using the National Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, years 2016–2017, we examined risk of severe maternal morbidity among 1,480,925 delivery hospitalizations among women of different races and with different numbers of comorbid conditions using multivariable logistic regression. RESULTS: The rate of severe maternal morbidity was 139.7 per 10,000 deliveries. Compared with women with no comorbidities (rate 48.5/10,000), there was increased risk of severe maternal morbidity among women with one comorbidity (rate 238.6; odds ratio [OR] 5.0, 95% CI 4.8–5.2), two comorbidities (rate 379.9; OR 8.1, 95% CI 7.8–8.5), or three or more comorbidities (rate 560; OR 12.1, 95% CI 11.5–12.7). In multivariable regressions, similar associations were noted for women with one (adjusted odds ratio [aOR] 4.4, 95% CI 4.2–4.6), two (aOR 6.6, 95% CI 6.3–6.9), or three or more comorbidities (aOR 9.1, 95% CI 8.7–9.6). Black women had higher rates of comorbid conditions than all other racial and ethnic groups, with 55% (95% CI 54–56%) of Black women having no comorbidities, compared with 67% (95% CI 67–68%) of White women, 68% (95% CI 67–69%) of Hispanic women, and 72% (95% CI 71–73%) of Asian women. CONCLUSION: We found a dose–response relationship between number of comorbidities and risk of severe maternal morbidity, with the highest rates of severe maternal morbidity among women with three or more comorbidities. Focusing on the prevention and treatment of chronic conditions among women of childbearing age may have the potential to improve maternal outcomes across races and ethnicities.

Perinatal mental health disorders are increasingly acknowledged as contributors to adverse maternal outcomes. We analyzed data from the Healthcare Cost and Utilization Project National Inpatient Sample (2016 and 2017) to estimate hospitalization cost, length-of-stay, and severe maternal morbidity associated with perinatal mental health disorders overall, as well as stratified by payer and by specific mental health category. We found that people with mental health disorders had $458 higher costs per delivery hospitalization and 50 percent higher rates of severe maternal morbidity compared with people without mental health disorders. We estimated increased annual delivery hospitalization costs of $102 million in the US among people with perinatal mental health conditions compared with those without. Furthermore, people diagnosed with trauma- or stress-related mental health disorders had even higher rates of hospitalization costs—$825 higher per delivery—and 87 percent higher rates of severe maternal morbidity compared with people without those diagnoses. These findings provide important information for perinatal mental health program feasibility and cost-effectiveness analyses and suggest the need for increased focus on trauma- and stress-related disorders.

OBJECTIVE: To examine trends and prevalence of lean diabetes among adults in the U.S. from 2015 to 2020, overall and stratified by age, sex, and race/ethnicity.RESEARCH DESIGN AND METHODS: An exploratory study design evaluated the prevalence and trends of lean diabetes among 2,630,463 (unweighted) adults aged ≥18 years who responded to the Behavioral Risk Factor Surveillance System (BRFSS), years 2015 to 2020.RESULTS: Diabetes increased significantly among lean adults with BMI of <25 kg/m2 from 4.5% (95% CI 4.3–4.7) in 2015 to 5.3% (95% CI 5.0–5.7) in 2020, representing a 17.8% increase (odds ratio 1.21; 95% CI 1.12–1.31), with no significant change among overweight/obese adults. Increases in diabetes prevalence among lean adults varied by subgroup with Black, Hispanic, and female populations seeing the largest growth.CONCLUSIONS: The prevalence of lean diabetes among the U.S. adult population is increasing, with larger increases among women and populations of color.

Using National Center for Health Statistics data (2016–20), we evaluated variation in low birthweight and prematurity among racial and ethnic subcategories. Disparities as large as 2.3-fold among rates of low birthweight for “multiple race” subcategories underscore the need for granular data stratification and analysis by racial and ethnic subcategories to address the root causes of inequities in infant outcomes.