Early Postpartum Severe Maternal Morbidity Among Mothers of Very Low and Low Birthweight Infants: A Population-Based Retrospective Cohort Study in Georgia, USA, 2016-2020

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BACKGROUND: The early postpartum period (first 42 days after delivery) is a high-risk window for severe maternal morbidity (SMM), yet clinical predictors are not well characterized. We examined rates and clinical factors that associate with early postpartum SMM by infant birthweight category to inform future intervention strategies. METHODS: We constructed a retrospective, population-based cohort of 542,702 live births in Georgia (2016-2020) using linked birth certificate and hospital discharge records. Infant birthweight was categorized as normal or above (NBW+, ≥2500 g), moderately low (LBW, 1500–2499 g), or very low (VLBW, <1500 g). We estimated early postpartum SMM rates, adjusted risk ratios (RRs), and population attributable risk percentages (PARs) for medical, obstetric, and delivery-related factors using multivariable modeling. RESULTS: Among 542,702 livebirths (492,190 NBW+; 41,337 LBW; 9,172 VLBW), early postpartum SMM rates were highest among VLBW (153 per 10,000) compared with LBW (76 per 10,000) and NBW+ (41 per 10,000) deliveries. Cesarean delivery was associated with the largest observed PAR for all birthweight categories (VLBW: 56.8%; LBW: 25.6%; NBW+: 26.8%) followed by SMM at delivery (VLBW: 15.0%; LBW: 11.4%; 4.2% for NBW+). Chronic and perinatal health conditions each accounted for ≤6% PAR. CONCLUSIONS: Women delivering VLBW and LBW infants experienced nearly four-fold and two-fold higher risks of early postpartum SMM, respectively, compared with NBW+ births. Delivery events, particularly cesarean and SMM at delivery, were associated with the greatest PAR of early postpartum SMM. Findings underscore the need for postpartum monitoring protocols, especially after complicated deliveries, and integrated models of maternal-infant care.

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