Validation of an Extended Maternal Comorbidity Index for Prediction of Severe Maternal Morbidity

Authors

Ann M. Bruno, University of Utah Health Sciences Center, Salt Lake City, Utah; The George Washington University Biostatistics Center, Washington, DC; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Northwestern University, Chicago, Illinois; the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Pittsburgh, Pittsburgh, and the University of Pennsylvania, Philadelphia, Pennsylvania; Brown University, Women and Infants Hospital of Rhode Island, Providence, Rhode Island; Columbia University, New York, New York; Case Western Reserve University, Cleveland, and The Ohio State University, Columbus, Ohio; and the University of Alabama at Birmingham, Birmingham, Alabama.
Grecio J. Sandoval
Brenna L. Hughes
William A. Grobman
George R. Saade
Tracy A. Manuck
Monica Longo
Hyagriv N. Simhan
Dwight J. Rouse
Hector Mendez-Figueroa
Cynthia Gyamfi-Bannerman
Jennifer L. Bailit
Maged M. Costantine
Harish M. Sehdev
Alan T. Tita

Document Type

Journal Article

Publication Date

6-12-2025

Journal

Obstetrics and gynecology

DOI

10.1097/AOG.0000000000005971

Abstract

The expanded maternal comorbidity index developed by Leonard et al uses pre-existing maternal health conditions (eg, hypertension, asthma) to produce a risk score that predicts severe maternal morbidity (SMM). This tool has been adopted into clinical and research use without external validation in a data source not reliant on administrative codes. We assessed the validity of the maternal comorbidity index to predict SMM in a modern obstetric cohort using data derived from detailed medical record abstraction. In this secondary analysis of a multicenter cohort of patients delivering at 17 U.S. hospitals (2019-2020), the maternal comorbidity index risk score was applied to all individuals and the performance of the score to predict SMM was assessed using the area under the receiver operating curve (AUC). Of 20,898 individuals in this cohort, 668 (3.2%) experienced SMM. The AUC for the maternal comorbidity index was 0.72 (95% CI, 0.70-0.74) to predict SMM and 0.83 (95% CI, 0.79-0.86) to predict SMM without transfusion. The expanded maternal comorbidity index for prediction of SMM was externally valid, and findings support the ongoing use of this tool.

APA Citation

Bruno, Ann M.; Sandoval, Grecio J.; Hughes, Brenna L.; Grobman, William A.; Saade, George R.; Manuck, Tracy A.; Longo, Monica; Simhan, Hyagriv N.; Rouse, Dwight J.; Mendez-Figueroa, Hector; Gyamfi-Bannerman, Cynthia; Bailit, Jennifer L.; Costantine, Maged M.; Sehdev, Harish M.; and Tita, Alan T., "Validation of an Extended Maternal Comorbidity Index for Prediction of Severe Maternal Morbidity" (2025). GW Authored Works. Paper 7422.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7422

Department

Biostatistics and Bioinformatics