Maternal risk beyond delivery and across populations

Two research articles in CMAJ examine gaps in how maternal risk is captured and how it varies across populations in Canada. One study shows that extending surveillance beyond delivery reveals a higher burden of severe maternal morbidity, particularly in the postpartum period. A second examines obstetric trauma, identifying differences across racial and immigration groups and pointing to structural and sociocultural factors that shape risk during delivery.

Dr. Giulia Muraca, an obstetrician-gynecologist at McMaster University and principal investigator on the first study, explains that extending surveillance beyond delivery increases estimated rates of severe maternal morbidity from 1.7% to 2.7%, representing nearly 10 000 affected pregnancies annually in Canada. Maya Rajasingham, a perinatal epidemiologist at McMaster and co-author, notes that 29% of these events occur postpartum, with sepsis emerging as a key contributor. Muraca adds that postpartum sepsis rates are substantially higher than previously reported, with most cases occurring in the first week after discharge. She also identifies acute appendicitis as the most frequent severe maternal morbidity in the antepartum period, a finding that remains underexplored in the Canadian literature. The findings suggest current surveillance windows underestimate the true burden of maternal morbidity.

In a second CMAJ study on obstetric trauma, Muraca again serves as principal investigator alongside Irina Oltean, a PhD candidate at McMaster and co-author. The study finds that obstetric trauma affects 5.5% of vaginal births, with substantial variation across racial groups. Oltean reports higher rates among Asian patients and lower rates among Black patients compared with White patients, even after adjusting for clinical factors. Among immigrants, risk declines with increasing time in Canada. The authors suggest this pattern reflects differences in communication, access to care, and familiarity with the health system rather than biological factors.

For clinicians, these studies suggest the need to expand the window of concern beyond delivery and to account for how social and structural factors shape risk across populations.

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