Academic Appointments

All Publications

  • Comparison between the old and new MFMU TOLAC Calculator - Which is more accurate? Gunaseelan, A., Cruz, G., El-Sayed, Y. Y., Johnson, C., Blumenfeld, Y. J. MOSBY-ELSEVIER. 2022: S394
  • MFMU TOLAC Calculator: Does knowledge of a predicted success score increase VBAC rates? Gunaseelan, A., Cruz, G., El-Sayed, Y. Y., Johnson, C., Blumenfeld, Y. J. MOSBY-ELSEVIER. 2022: S775
  • Stimulant medications for attention deficit/hyperactivity disorder and maternal and neonatal outcomes Johnson, C., Kan, P., Leonard, S. A., Lee, H. C., Jacobs, L., Lyell, D. J. MOSBY-ELSEVIER. 2021: S615
  • Obstetric comorbidity scores and disparities in severe maternal morbidity across marginalized groups. American journal of obstetrics & gynecology MFM Leonard, S. A., Main, E. K., Lyell, D. J., Carmichael, S. L., Kennedy, C. J., Johnson, C., Mujahid, M. S. 2021: 100530


    A recently developed obstetric comorbidity scoring system enables comparisons of severe maternal morbidity rates independent of health status at the time of birth hospitalization. However, the scoring system has not been evaluated in racial-ethnic and socioeconomic groups or used to assess disparities in severe maternal morbidity.To evaluate the performance of applying an obstetric comorbidity scoring system across racial-ethnic and socioeconomic groups and to determine the effect of comorbidity score risk adjustment on disparities in severe maternal morbidity.We analyzed a population-based cohort of live births in California during 2011-2017 with linked birth certificate and birth hospitalization discharge data (n = 3,308,554). We updated a previously developed comorbidity scoring system to include ICD-9-CM and ICD-10-CM diagnosis codes, and applied the scoring system in subpopulations (groups) defined by race-ethnicity, nativity, payment method, and educational attainment. We then calculated risk-adjusted rates of severe maternal morbidity (including and excluding blood transfusion-only cases) in each group and estimated disparities for these outcomes before and after adjustment for the comorbidity score using logistic regression.The obstetric comorbidity scores performed consistently across groups (C-statistics ranged from 0.68-0.76; calibration curves demonstrated overall excellent prediction of absolute risk). All non-White groups had significantly elevated rates of severe maternal morbidity before and after risk adjustment for comorbidities compared to the White group (1.3% before, 1.3% after): American Indian-Alaska Native (2.1% before, 1.8% after), Asian (1.5% before, 1.7% after), Black (2.5% before, 2.0% after), Latinx (1.6% before, 1.7% after), Pacific Islander (2.2% before, 1.9% after), and Multi-race groups (1.7% before, 1.6% after). Risk adjustment also modestly increased disparities for the foreign-born group and non-commercial insurance groups. Increasing educational attainment was associated with decreasing severe maternal morbidity rates, which was largely unaffected by comorbidity risk adjustment. The pattern of results was the same whether or not transfusion-only cases were included as severe maternal morbidity.These results support the use of an updated comorbidity scoring system to assess disparities in severe maternal morbidity. Disparities in severe maternal morbidity decreased in magnitude for some racial-ethnic and socioeconomic groups and increased in magnitude for others after adjustment for the comorbidity score.

    View details for DOI 10.1016/j.ajogmf.2021.100530

    View details for PubMedID 34798329