Neonatal Outcomes Associated with Maternal-Factor-Related Diagnoses: Real-World Evidence from a National Inpatient Database (2010-2025).

Abstract

Background/objectives: Maternal conditions and lifestyle exposures strongly influence neonatal morbidity, but population-level longitudinal data from Central and Eastern Europe remain limited. This nationwide study evaluated 16-year trends (2010-2025) in neonatal hospital episodes with maternal-factor-related diagnostic codes (ICD-10 P00, P04, and P70.0-P70.1) in Hungary and quantified associations with severe clinical attributes.

Methods: In a retrospective study of 1,546,439 hospital birth episodes, administrative registry data were analysed. Cases with ICD-10 codes P00.0-P00.9 (maternal conditions), P04.0-P04.9 (noxious influences/lifestyle), and P70.0-P70.1 (carbohydrate disorders) were identified. Severity levels, birth weight, surgical interventions, and mechanical ventilation were derived from the Hungarian Diagnosis-Related Group (h-DRG) labels. Temporal trends were evaluated using Joinpoint regression, and episode-level prevalence ratios (PR) with 95% confidence intervals were estimated compared with neonates without recorded maternal factor-related ICD-10 diagnoses.

Results: Maternal-factor codes were present in 145,571 episodes (9.41%; P70: 49.96%, P00: 31.33%, P04: 18.71%). Case rates per 1000 live births increased for P04 (7.08-fold), P00 (6.88-fold), and P70 (2.59-fold; overall AAPC: 9.98%, 95% CI: 9.12-10.85). Maternal-factor episodes had a higher prevalence of severe morbidity (PR = 2.18, 95% CI: 2.13-2.23), birth weight 1500-1999 g (PR = 2.27, 95% CI: 2.20-2.34), major surgery (PR = 2.18, 95% CI: 1.86-2.56), and mechanical ventilation > 5 days (PR = 5.04, 95% CI: 4.62-5.51). Mean length of stay increased by 11.05% in P04 episodes (from 4.14 to 4.60 days) and decreased by 15.59% and 23.60% in P00 and P70.0-P70.1 episodes, respectively.

Conclusions: Maternal-factor conditions were recorded in nearly one in ten neonatal hospital delivery episodes in Hungary, showing an increase in recorded episode rates and resource use. These coded episodes are associated with a higher prevalence of low birth weight, major surgery, and prolonged mechanical ventilation.