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Purpose To study the effect of maternal psychiatric disorders (depression, anxiety disorder, bipolar disease, schizophrenia, unspecified psychiatric disorder, and comorbid conditions) and odds of preterm birth. Methods The Consortium on Safe Labor (2002-2008), an observational cohort with 12 centers from across the U.S. included 223,394 singleton pregnancies with clinical data obtained from electronic medical records and maternal diagnoses of psychiatric disorders from maternal discharge summaries. Length of gestation was based on the best clinical estimate and categorized as birth <39, <37, <34 and <28 weeks’ gestation. The adjusted odds ratios (ORs) with 95% confidence intervals of birth were estimated by logistic regression with generalized estimating equations. Results Any maternal psychiatric disorder was associated with odds of birth <39 weeks’ gestation (OR=1.32, 95% confidence interval 1.28-1.37), <37 weeks’ gestation (OR=1.45, 1.38-1.52), <34 weeks’ gestation (OR=1.47, 1.35-1.59) and <28 weeks’ gestation (OR=1.57, 1.36-1.82). Specifically, odds of birth <37 weeks’ gestation were associated with maternal depression (OR=1.31, 1.23-1.40), anxiety disorder (OR=1.68, 1.41-2.01), depression with anxiety disorder (OR=2.31, 1.93-2.78), bipolar disease (OR=1.54, 1.22-1.94), bipolar disease with depression and=or anxiety disorder (OR=1.70, 1.30-2.22) and unspecified psychiatric disorder (OR=1.52, 1.41-1.64). Conclusions Maternal psychiatric disorders, especially comorbid psychiatric conditions, were associated with increased likelihood of preterm birth.

Objective To evaluate the effect of maternal chronic disease on obstetric complications among twin pregnancies. Design Multicenter retrospective observational study. Setting The 12 Consortium on Safe Labor (CSL) clinical centers (19 hospitals). Patient(s) Twin pregnancies (n=4,821) delivered ≥ 23 weeks of gestation and classified by maternal chronic disease (either none or any of the following: asthma, depression, hypertension, diabetes, and heart, thyroid, gastrointestinal or renal disease). Intervention(s) None. Main Outcome Measure(s) Gestational age at delivery, gestational hypertension, preeclampsia, gestational diabetes, placental abruption, placenta previa, hemorrhage, chorioamnionitis, maternal postpartum fever, premature rupture of membranes, labor onset (spontaneous versus nonspontaneous), route of delivery, and maternal admission to intensive care unit. Result(s) Women with chronic disease delivered earlier (mean gestational length, 34.1 vs. 34.6 weeks, p<0.0001) and were less likely to have term birth (risk ratio (RR): 0.80; 95% confidence interval (95% CI): 0.70-0.90). Cesarean delivery after spontaneous labor (RR: 1.20; 95% CI: 1.05-1.37) was also increased with chronic disease. No statistically significant effects were observed for other complications studied. Women who used ART were more likely to hemorrhage, independent of chronic disease, but other findings were generally similar to the non-ART sample. Conclusion(s) Chronic disease was associated with additional risk of earlier delivery and cesarean section after spontaneous labor in a nationwide sample of US twin pregnancies. Capsule Among twin pregnancies, maternal chronic disease was associated with additional risk of earlier delivery and cesarean section after spontaneous labor, but not with other obstetric complications.