Risk of severe maternal morbidity by location of residence in Georgia

Rates of severe maternal morbidity (SMM) have increased nationally over recent decades, and Georgia has among the highest rates in the nation. Location of patient residence has been identified as a contributing factor for SMM, but existing surveillance has not evaluated SMM risk by residential location in Georgia. Our objective was to describe rates of SMM by residence in Georgia. This population cohort study included all delivery hospitalizations in Georgia from 2016-2020 with birth record linked to hospital discharge data. Inclusion criteria were age 12-55 years, gestational age ≥ 22 weeks, and primary residence and delivery within Georgia. Delivery hospitalizations were identified using ICD-10 diagnosis and procedure codes on the discharge abstract and birth dates on the vital records. The exposure of interest was location of residence, categorized with the National Center for Health Statistics Urban-Rural Classification Scheme for Counties as follows: large metropolitan, medium metropolitan, small metropolitan, micropolitan, or rural. The outcome of interest was a composite measure of SMM and clinical SMM subcategories as follows: cardiovascular, hematological, infectious, obstetric, renal, respiratory. 527,837 delivery admissions were identified within the timeframe. SMM complicated 2.03% of all admissions. SMM rate was highest among deliveries in the large metropolitan region (2.27%). Rural residents were the next highest risk group, with 2.08% of deliveries complicated by SMM. The cardiovascular SMM rate was highest among rural residents (0.19%), while the rates of all other subtypes were highest among large metropolitan residents. Residents of large metropolitan areas of Georgia are at highest risk of SMM during the delivery admission. However, rural residents are at greatest risk of cardiovascular SMM. These findings are essential to inform policy and guide implementation of practice-based solutions to the existing maternal health crisis in Georgia.