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Gestational weight gain and modifiable risk factors of severe maternal morbidity in a hospital-based, retrospective cohort

Freese, Kyle (2020) Gestational weight gain and modifiable risk factors of severe maternal morbidity in a hospital-based, retrospective cohort. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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PSevere maternal morbidity affects nearly 50,000 women every year and its incidence has risen over the past 3 decades. However, there remain several gaps in the epidemiologic literature. Our goal was to quantify the burden that modifiable risk factors place on severe maternal morbidity, with a focus on gestational weight gain because of its amenability to intervention during pregnancy.
We used two, retrospective cohorts of delivery hospitalizations at Magee-Womens Hospital in Pittsburgh, PA to address three specific aims: 1) determine the association between total gestational weight gain and the risk of severe maternal morbidity, 2) determine the association between early gestational weight gain and the risk of severe maternal morbidity, and 3) calculate the population attributable fraction of known, modifiable risk factors of severe maternal morbidity.
A total gestational weight gain z-score of +2 (31kg at 40 weeks gestation among normal weight women) was associated with 1.0 (0.46, 1.5)) excess cases of severe maternal morbidity per 100 delivery hospitalizations compared with a z-score of 0 (16kg at 40 weeks among normal weight). Very low weight gain was also associated with an increased risk, though the magnitude of association was smaller. The relationship between early gestational weight gain and risk of severe maternal morbidity followed an inverted-U distribution, though the divergent findings with Specific Aim #1 were likely due to differences in sample characteristics. For Specific Aim #3, we found that optimizing eight, known risk factors concurrently could prevent 36% (626 cases) of the severe maternal morbidities in this sample. High gestational weight gain, high body mass index, advanced maternal age, preexisting hypertension, and lack of a college degree had population attributable fractions ranging from 4.5% to 13%.
Our results suggest that optimizing individual-level risk factors, including gestational weight gain, would have modest impacts on reducing risk of severe maternal morbidity and that the burden of severe maternal morbidity is likely due to a constellation of components. This is significant for future public health efforts because, while additional research should confirm and extend our findings, the greatest change will likely come through addressing larger, population-level factors and disparities.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairBodnar,
Committee MemberHimes,
Committee MemberBrookes,
Committee MemberMcTigue,
Date: 29 January 2020
Date Type: Publication
Defense Date: 25 September 2019
Approval Date: 29 January 2020
Submission Date: 17 November 2019
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 155
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Severe maternal morbidity; gestational weight gain; population attributable fraction
Date Deposited: 29 Jan 2020 21:20
Last Modified: 29 Jan 2020 21:20


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