Interpretation
The CPMs in this study relied on information that is routinely known at
the time of the first antenatal visit, and that is temporally remote
from when most morbid events arise – around the time of
birth.9 Our main CPM shows the potential utility of
harnessing data in early pregnancy to predict a variety of later adverse
maternal outcomes. Consistent with previous research on postnatal
mortality,21 our CPM for all-cause mortality showed
substance use, alcohol use, and psychiatric conditions to be significant
predictors of death up to 365 days postpartum.
Severe maternal morbidity rates have stagnated within Western nations,
yet evidence-based strategies to reduce their burden are
lacking.9 With further refinement of this CPM, a
clinical risk calculator could be developed to help triage women for
enhanced surveillance or referral to subspecialty care or shared-care
antenatal pathways – decisions that at present rely principally on
clinical judgment. The development and refinement of future CPMs for
severe maternal morbidity should consider adding first-trimester
placental biomarkers and other maternal biomarkers alongside routinely
measured clinical variables, such as blood pressure and weight. The
availability of such variables might facilitate prediction of the whole
of severe morbidity as well as cause-specific outcomes, and better
inform individualized and targeted prevention.35