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Importance: More pregnant women have complex medical histories known to increase maternal morbidity and mortality.  While the association between individual co-morbidities and complications has been studied, the joint effect of multiple pre-gestational diagnoses is unclear. 

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Objective: To determine the most common combinations of pre-gestational diagnoses and their potential synergistic effects on common pregnancy-related complications.

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Design: This was a cross-sectional study of data from the 2016 Healthcare Cost and Utilization Project’s National Inpatient Sample database.  A chi-squared analyses of combinations of pre-gestational diagnoses was performed to assess the relative risk of pregnancy-related complications.

Setting: Largest all payer hospital inpatient care database in the United States. 

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Participants: Inclusion criteria were: Diagnosis Related Groups assumed to be associated with delivery, and three or less ICD 10 codes with a prevalence greater than or equal to 0.5% or clinically important risk factors in Bateman’s co-morbidity index.  Exclusion criteria included: Diagnosis Related Groups assumed not to be associated with delivery, uncommon diagnoses not defined a-priori, missing ICD 10 codes, or four or more ICD 10 codes.  

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Main outcome and measure: Most common combination of diagnoses and the relative risk of complications.

Enter diagnosis #1
Enter diagnosis #2
Diagnosis 1
Diagnosis 2
Compared to
None
GDM
Laceration
Meconium
Non-Vtx
NRFHT
Pre-E
IUGR
LGA
Hemorrhage
Anemia
Advanced maternal age
No diagnosis
0.86
0.39
1.13
1.36
1
1.07
0.89
0.4
3.06
6.24
Anemia
Advanced maternal age
Anemia
0.92
3.08
0.95
1.11
1.72
1.08
1.11
0.98
1.17
0.88
Anemia
Advanced maternal age
Advanced maternal age
1.1
1.06
0.79
1.06
1.11
1.11
1.26
1.33
0.8
11.99
Anemia
Obesity
No diagnosis
0.95
0.42
0.89
1.68
0.59
1.35
1.95
0.35
6.74
7.3
Anemia
Obesity
Obesity
1.04
1.09
0.83
0.81
0.72
1.08
0.89
1.23
0.87
11
No diagnosis
No diagnosis
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Pregestational DM
No diagnosis
N/A
0.95
0.21
0.93
0.68
0.99
1.45
2.71
No cases
20.33
0.9
Hypertension
No diagnosis
N/A
1.19
0.36
1.08
0.64
0.57
0.92
1.62
0.32
2.12
0.57
Previous cesarean
No diagnosis
N/A
2.29
0.46
0.17
1
0.49
0.29
1.12
0.37
2.67
0.74
Psychiatric diagnosis
No diagnosis
N/A
1.05
0.13
1.35
1.6
0.38
0.75
0.8
0.38
1.88
0.5
Fibroid
No diagnosis
N/A
0.73
0.27
1.06
0.98
2.72
1.78
1.18
0.39
5.5
No cases
Advanced maternal age
No diagnosis
N/A
0.78
0.37
1.43
1.29
0.9
0.96
0.71
0.3
3.82
0.52

GDM: gestational diabetes

Pre-E: Pre-eclampsia

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Note: some combinations of diagnoses were not studied together due to low prevalence (for example, there were very few patients with pre-gestational diabetes and no other diagnoses). If the combination was not able to be studied, the table will return blank results.

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