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Open Access
CC BY 4.0 · Am J Perinatol 2026; 43(03): 344-354
DOI: 10.1055/a-2618-7331
Original Article

Hospital Costs of Severe Maternal Morbidity Hospitalizations in the United States from 2014 to 2019: A Nationwide Cross-Sectional Study

Authors

  • Mohammad A. Salameh 

    1   Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota

  • Megan E. Branda

    2   Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota

  • Bijan J. Borah

    3   Department of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota

  • Vanessa E. Torbenson

    1   Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota

Funding This study was funded by the Obstetrics and Gynecology Department at Mayo Clinic. The work was supported, in part, by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
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Abstract

Objective

The objective of this study was to estimate the average hospitalization cost (AHC) for deliveries affected by severe maternal morbidity (SMM) and analyze trends from 2014 to 2019. The study also aimed to explore cost stratification based on patient, delivery, and hospital characteristics.

Study Design

Using the National Inpatient Sample dataset, all delivery hospitalizations from 2014 to 2019 were identified. Deliveries affected by SMM were determined based on the Centers for Disease Control definition. Deliveries were categorized into three groups: no SMM (nSMM), any SMM (aSMM), and SMM excluding cases with blood transfusion as the only indicator (SMMeBTo). A regression model accounting for survey design and adjusting for variables including age, race/ethnicity, primary payer, income, delivery method, hospital location/teaching status, and hospital region was used to test the trends in incidence. Hospital charges were adjusted using cost-to-charge ratios and presented in 2022 U.S. dollars ($). A regression model adjusting for the same variables was used to assess costs.

Results

From 2014 to 2019, 4,444,957 deliveries were identified, with a weighted estimate of 22,224,775. The rates of aSMM and SMMeBTo were 1.9 and 0.7%, respectively. AHC was $5,218 (95% confidence intervals [CI]: $5,200–5,235) for nSMM, $11,101 (95% CI: $11,038–11,165) for aSMM, and $11,541 (95% CI: $114,330–11,650) for SMMeBTo. Hospitalization costs across all SMM categories rose annually from 2014 to 2017, decreased in 2018, and peaked in 2019. All races had significantly higher costs than non-Hispanic Whites across all SMM categories. SMM costs were higher for cesarean deliveries. The highest cost was in deliveries involving a temporary tracheostomy. Urban teaching hospitals and those in the Northeast had the highest SMM costs.

Conclusion

Deliveries affected by SMM incur significantly higher costs, with these costs increasing over time. Understanding disparities across patient factors, delivery methods, and hospital characteristics can inform interventions aimed at addressing inequities.

Key Points

  • Costs of SMM hospitalizations are rising, even after adjusting for inflation.

  • The escalating cost burden is disproportionately shouldered by different racial groups.

  • Factors in delivery and hospital settings contribute to the variation in cost.

Keywords

severe maternal morbidity - administrative data - hospitalization cost - health disparities

Supplementary Material



Publication History

Received: 28 February 2025

Accepted: 18 May 2025

Accepted Manuscript online:
22 May 2025

Article published online:
11 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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