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Incidence and risk factors of maternal sepsis in California

Principal investigator
Marian Knight (NPEU)
Audrey Lyndon (University of California San Francisco, San Francisco, USA), Henry Lees (Stanford University, Palo Alto, California, USA), Jeffery Gould (Stanford University, Palo Alto, California, USA), Colleen Acosta-Nielsen (NPEU (Former member)), Jenny Kurinczuk (NPEU)
Severe maternal morbidity and mortality
National Institute for Health Research
Start year
End year
NPEU Contact
Marian Knight


In countries with developed healthcare systems, sepsis remains a leading cause of preventable maternal morbidity and mortality. The objective of this study was to investigate the incidence and risk factors associated with maternal sepsis and progression to severe sepsis in a large population-based birth cohort from California.

The study showed that the incidence of severe sepsis was 4.7/10,000 births (95% CI=4.4-5.1). Women had significantly increased adjusted odds of progressing to severe sepsis if they were Black (OR=2.09), Asian (OR=1.59), Hispanic (OR=1.42), had public or no health insurance (OR=1.52), delivered in hospitals with an annual delivery rate of <1,000 births (OR=1.93), were primiparous (OR=2.03), had a multiple birth (OR=3.5), diabetes (OR=1.47), or chronic hypertension (OR=8.51). Preeclampsia and postpartum hemorrhage were also significantly associated with progression to severe sepsis (OR=3.72; OR=4.18). Factors had a significantly cumulative effect on risk of progression to severe sepsis.

This study suggested that the rate of severe sepsis was greater than that of the 1991-2003 national estimate. Risk factors identified are relevant to obstetric practice given the apparent increase in severe maternal sepsis.