Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes

John Masterson; Imad Adamestam; Monika Beatty; James P Boardman; Louis Chislett; Pamela Johnston; Judith Joss; Heather Lawrence; Kerry Litchfield; Nicholas Plummer; Stella Rhode; Timothy S. Walsh; Arlene Wise; Rachael Wood; Christopher J Weir; Nazir I Lone

doi:10.1007/s00134-024-07417-4

Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes

John Masterson, Imad Adamestam, Monika Beatty, James P Boardman, Louis Chislett, Pamela Johnston, Judith Joss, Heather Lawrence, Kerry Litchfield, Nicholas Plummer, Stella Rhode, Timothy S. Walsh, Arlene Wise, Rachael Wood, Christopher J Weir, Nazir I Lone^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Purpose
Factors increasing the risk of maternal critical illness are rising in prevalence in maternity populations. Studies of general critical care populations highlight that severe illness is associated with longer-term physical and psychological morbidity. We aimed to compare short- and longer-term outcomes between women who required critical care admission during pregnancy/puerperium and those who did not.

Methods
A cohort study including all women delivering in Scottish hospitals between 01/01/2005-31/12/2018, using national healthcare databases. The primary exposure was Intensive Care Unit (ICU) admission, whilst secondary exposures included High Dependency Unit admission. Outcomes included hospital readmission (1-year post-hospital discharge, 1-year mortality, psychiatric hospital admission, stillbirth and neonatal critical care admission). Multivariable Cox and logistic regression were used to report hazard ratios (HR) and odds ratios (OR) of association between ICU admission and outcomes.

Results
Of 762,918 deliveries, 1,449 (0.18%) women were admitted to ICU, most commonly due to post-partum haemorrhage (225, 15.5%) followed by eclampsia/pre-eclampsia (133, 9.2%). Over-half (53.8%) required mechanical ventilation. One-year hospital readmission was more frequent in women admitted to ICU compared with non-ICU populations (24.5% (n=299) vs 8.9% (n=68,029)). This association persisted after confounder adjustment (HR=1.93, 95%CI 1.33, 2.81, p<0.001). Furthermore, maternal ICU admission was associated with increased 1-year mortality (HR=40.06, 95%CI 24.04,66.76, p<0.001, stillbirth (OR=12.31, 95%CI 7.95,19.08,p<0.001) and neonatal critical care admission (OR=6.99, 95%CI 5.64 ,8.67, p<0.001) after confounder adjustment.

Conclusion
Critical care admission increases the risk of adverse short-term and long-term maternal, pregnancy and neonatal outcomes. Optimising long-term post-partum care may benefit maternal critical illness survivors.

Original language	English
Pages (from-to)	890-900
Number of pages	11
Journal	Intensive Care Medicine
Volume	50
DOIs	https://doi.org/10.1007/s00134-024-07417-4
Publication status	Published - 7 Jun 2024

Keywords / Materials (for Non-textual outputs)

Maternal critical care
Maternal mortality
Hospitalization
Stillbirth
Neonatal outcomes

Access to Document

10.1007/s00134-024-07417-4

2024-03-20 Main manuscript_cleanAccepted author manuscript, 83.2 KBLicence: Creative Commons: Attribution (CC-BY)

Cite this

Masterson, J., Adamestam, I., Beatty, M., Boardman, J. P., Chislett, L., Johnston, P., Joss, J., Lawrence, H., Litchfield, K., Plummer, N., Rhode, S., Walsh, T. S., Wise, A., Wood, R., Weir, C. J., & Lone, N. I. (2024). Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes. Intensive Care Medicine, 50, 890-900. https://doi.org/10.1007/s00134-024-07417-4

@article{b163116b98474d2ea20b74f752e2da61,

title = "Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes",

abstract = "PurposeFactors increasing the risk of maternal critical illness are rising in prevalence in maternity populations. Studies of general critical care populations highlight that severe illness is associated with longer-term physical and psychological morbidity. We aimed to compare short- and longer-term outcomes between women who required critical care admission during pregnancy/puerperium and those who did not. MethodsA cohort study including all women delivering in Scottish hospitals between 01/01/2005-31/12/2018, using national healthcare databases. The primary exposure was Intensive Care Unit (ICU) admission, whilst secondary exposures included High Dependency Unit admission. Outcomes included hospital readmission (1-year post-hospital discharge, 1-year mortality, psychiatric hospital admission, stillbirth and neonatal critical care admission). Multivariable Cox and logistic regression were used to report hazard ratios (HR) and odds ratios (OR) of association between ICU admission and outcomes. ResultsOf 762,918 deliveries, 1,449 (0.18%) women were admitted to ICU, most commonly due to post-partum haemorrhage (225, 15.5%) followed by eclampsia/pre-eclampsia (133, 9.2%). Over-half (53.8%) required mechanical ventilation. One-year hospital readmission was more frequent in women admitted to ICU compared with non-ICU populations (24.5% (n=299) vs 8.9% (n=68,029)). This association persisted after confounder adjustment (HR=1.93, 95%CI 1.33, 2.81, p<0.001). Furthermore, maternal ICU admission was associated with increased 1-year mortality (HR=40.06, 95%CI 24.04,66.76, p<0.001, stillbirth (OR=12.31, 95%CI 7.95,19.08,p<0.001) and neonatal critical care admission (OR=6.99, 95%CI 5.64 ,8.67, p<0.001) after confounder adjustment. ConclusionCritical care admission increases the risk of adverse short-term and long-term maternal, pregnancy and neonatal outcomes. Optimising long-term post-partum care may benefit maternal critical illness survivors.",

keywords = "Maternal critical care, Maternal mortality, Hospitalization, Stillbirth, Neonatal outcomes",

author = "John Masterson and Imad Adamestam and Monika Beatty and Boardman, {James P} and Louis Chislett and Pamela Johnston and Judith Joss and Heather Lawrence and Kerry Litchfield and Nicholas Plummer and Stella Rhode and Walsh, {Timothy S.} and Arlene Wise and Rachael Wood and Weir, {Christopher J} and Lone, {Nazir I}",

year = "2024",

month = jun,

day = "7",

doi = "10.1007/s00134-024-07417-4",

language = "English",

volume = "50",

pages = "890--900",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer",

}

Masterson, J, Adamestam, I, Beatty, M, Boardman, JP, Chislett, L, Johnston, P, Joss, J, Lawrence, H, Litchfield, K, Plummer, N, Rhode, S , Walsh, TS , Wise, A , Wood, R , Weir, CJ & Lone, NI 2024, 'Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes', Intensive Care Medicine, vol. 50, pp. 890-900. https://doi.org/10.1007/s00134-024-07417-4

TY - JOUR

T1 - Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes

AU - Masterson, John

AU - Adamestam, Imad

AU - Beatty, Monika

AU - Boardman, James P

AU - Chislett, Louis

AU - Johnston, Pamela

AU - Joss, Judith

AU - Lawrence, Heather

AU - Litchfield, Kerry

AU - Plummer, Nicholas

AU - Rhode, Stella

AU - Walsh, Timothy S.

AU - Wise, Arlene

AU - Wood, Rachael

AU - Weir, Christopher J

AU - Lone, Nazir I

PY - 2024/6/7

Y1 - 2024/6/7

N2 - PurposeFactors increasing the risk of maternal critical illness are rising in prevalence in maternity populations. Studies of general critical care populations highlight that severe illness is associated with longer-term physical and psychological morbidity. We aimed to compare short- and longer-term outcomes between women who required critical care admission during pregnancy/puerperium and those who did not. MethodsA cohort study including all women delivering in Scottish hospitals between 01/01/2005-31/12/2018, using national healthcare databases. The primary exposure was Intensive Care Unit (ICU) admission, whilst secondary exposures included High Dependency Unit admission. Outcomes included hospital readmission (1-year post-hospital discharge, 1-year mortality, psychiatric hospital admission, stillbirth and neonatal critical care admission). Multivariable Cox and logistic regression were used to report hazard ratios (HR) and odds ratios (OR) of association between ICU admission and outcomes. ResultsOf 762,918 deliveries, 1,449 (0.18%) women were admitted to ICU, most commonly due to post-partum haemorrhage (225, 15.5%) followed by eclampsia/pre-eclampsia (133, 9.2%). Over-half (53.8%) required mechanical ventilation. One-year hospital readmission was more frequent in women admitted to ICU compared with non-ICU populations (24.5% (n=299) vs 8.9% (n=68,029)). This association persisted after confounder adjustment (HR=1.93, 95%CI 1.33, 2.81, p<0.001). Furthermore, maternal ICU admission was associated with increased 1-year mortality (HR=40.06, 95%CI 24.04,66.76, p<0.001, stillbirth (OR=12.31, 95%CI 7.95,19.08,p<0.001) and neonatal critical care admission (OR=6.99, 95%CI 5.64 ,8.67, p<0.001) after confounder adjustment. ConclusionCritical care admission increases the risk of adverse short-term and long-term maternal, pregnancy and neonatal outcomes. Optimising long-term post-partum care may benefit maternal critical illness survivors.

AB - PurposeFactors increasing the risk of maternal critical illness are rising in prevalence in maternity populations. Studies of general critical care populations highlight that severe illness is associated with longer-term physical and psychological morbidity. We aimed to compare short- and longer-term outcomes between women who required critical care admission during pregnancy/puerperium and those who did not. MethodsA cohort study including all women delivering in Scottish hospitals between 01/01/2005-31/12/2018, using national healthcare databases. The primary exposure was Intensive Care Unit (ICU) admission, whilst secondary exposures included High Dependency Unit admission. Outcomes included hospital readmission (1-year post-hospital discharge, 1-year mortality, psychiatric hospital admission, stillbirth and neonatal critical care admission). Multivariable Cox and logistic regression were used to report hazard ratios (HR) and odds ratios (OR) of association between ICU admission and outcomes. ResultsOf 762,918 deliveries, 1,449 (0.18%) women were admitted to ICU, most commonly due to post-partum haemorrhage (225, 15.5%) followed by eclampsia/pre-eclampsia (133, 9.2%). Over-half (53.8%) required mechanical ventilation. One-year hospital readmission was more frequent in women admitted to ICU compared with non-ICU populations (24.5% (n=299) vs 8.9% (n=68,029)). This association persisted after confounder adjustment (HR=1.93, 95%CI 1.33, 2.81, p<0.001). Furthermore, maternal ICU admission was associated with increased 1-year mortality (HR=40.06, 95%CI 24.04,66.76, p<0.001, stillbirth (OR=12.31, 95%CI 7.95,19.08,p<0.001) and neonatal critical care admission (OR=6.99, 95%CI 5.64 ,8.67, p<0.001) after confounder adjustment. ConclusionCritical care admission increases the risk of adverse short-term and long-term maternal, pregnancy and neonatal outcomes. Optimising long-term post-partum care may benefit maternal critical illness survivors.

KW - Maternal critical care

KW - Maternal mortality

KW - Hospitalization

KW - Stillbirth

KW - Neonatal outcomes

U2 - 10.1007/s00134-024-07417-4

DO - 10.1007/s00134-024-07417-4

M3 - Article

SN - 0342-4642

VL - 50

SP - 890

EP - 900

JO - Intensive Care Medicine

JF - Intensive Care Medicine

ER -

Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes

Abstract

Keywords / Materials (for Non-textual outputs)

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