743: Maternal complications associated with low birthweight delivery

Abstract

Delivery of an infant at the extremes of birthweight (bwg) is associated with high neonatal morbidity however there is a paucity of literature regarding maternal complications associated with delivery of an infant the cusp of viability. We sought to quantify the rate of maternal complications by neonatal bwg. Population-based retrospective cohort study of all live births in Ohio (2006-2015) using birth certificate data. Frequency of maternal complications were stratified by neonatal bwg in increments of 250g (0-249g to ≥ 5,550g). Obstetric characteristics were compared between women who delivered in the cumulative “highest risk” bwg group (<1500g) to the referent lowest risk bwg group (2500-4000g). Multivariate logistic regression estimated the relative influence of low bwg (<1500g) on the outcome of maternal complications at delivery. Of the 1,462,995 live births in Ohio during the 10-year study period, the highest rates of each complication per associated bwg group were; cesarean delivery (CD), (76.7%; 1250-1499g), blood transfusion (3.9%; <250g), unplanned operation (6.6%; <250g), unplanned hysterectomy (0.26%; 250-499g), uterine rupture (1.5%; 1000-1249g), maternal ICU admission (1.5%; 750-999g), maternal hospital transfer (17.5%; 500-749g), chorioamnionitis (12.3%; 250-499g), cerclage (6.1%; 250-499g), and higher-degree perineal laceration (2.4%; 4750-4999g). The cumulative complication rate for transfusion, unplanned operation, maternal ICU admission, and chorioamnionitis was highest in the <250g bwg group at 23.0%. Birth of an infant <1500g was associated with an increased risk of CD (aOR 2.5, 95% CI 2.4-2.6). Even after exclusion of women who had a CD, delivery of a singleton infant with bwg <1500g was associated with chorioamnionitis (aOR 10.2, 95% CI 9.1-11.5), ICU admission (aOR 4.7, 95% CI 2.2-9.9), and blood product transfusion (aOR 2.1, 95% CI 1.3-3.5). Birth of an infant < 1500g (low birthweight) is not only associated with complications of prematurity but also high rates of maternal morbidity secondary to CD and other operative complications. Counseling and discussions regarding maternal risks should be considered for a mother at risk of preterm birth. Additionally, these risks should be reflected when determining the societal cost of a preterm birth on the population and support further perinatal efforts on primary prevention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)