Costs per infant hospitalization were highest for extremely preterm infants, although the larger number of moderately preterm/low birth weight infants contributed more to the overall costs. Preterm/low birth weight infants in the United States account for half of infant hospitalization costs and one quarter of pediatric costs, suggesting that major infant and pediatric cost savings could be realized by preventing preterm birth.

Objective-This study measured rates of and determined factors associated with mental health service use among a cohort of 465 pregnant and postpartum women receiving care at publicly funded obstetrical clinics.Methods-Women underwent a diagnostic evaluation, were provided with at least one mental health referral, and were encouraged to seek treatment; follow-up with provision of additional referrals occurred at 1, 3, and 6 months after the initial assessment. Logistic regression was used to estimate the relationship between clinical and psychosocial factors and self-reported mental health service use.Results-38.1% of referred women attended at least one mental health visit while only 6% of women remained in treatment during the entire 6-month follow-up interval. Postpartum women were more likely than pregnant women to attend a mental health treatment visit (O.R. = 4.17). Being born in the United States (O.R = 2.06), exposed to interpersonal violence (O.R. = 2.52), and unemployed (O.R. = 2.69) were associated with attending at least one mental health care visit. Women who received a behavioral health referral to the same site as their prenatal or postpartum care were more likely than those women referred offsite to attend a mental health treatment visit (O.R. = 3.23).Conclusions-Despite active follow-up, rates of accessing and particularly continuing in mental health treatment were low. More work is needed to support the integration of specialty behavioral health services in primary care settings accessed by perinatal women.

Background-The purpose of this study was to determine the association between posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, and the risk of delivering a low birthweight (<2500 grams) or preterm (<37 weeks gestational age) infant.

Birth defects remain the leading cause of infant death in the United States, despite the changes that resulted in 1999 from an update in the coding of cause of death from ICD-9 to ICD-10. While birth defects-specific IMRs provide an overall picture of fatal birth defects and a gauge of the impact of life-threatening anomalies, they represent only a fraction of the impact of birth defects, missing those who survive past infancy and those birth defects related losses in the antepartum period. Expansion and support of effective birth defects monitoring systems in each state that include the full spectrum of perinatal outcomes must be a priority. However, paralleling these efforts, analyses of this leading cause of infant mortality provide critical insight into perinatal health and should continue, with appropriate adjustments for the 1999 classification changes.

Detection rates for depressive disorders in obstetric settings are lower than those for panic disorder and lower than those reported in other primary care settings. Consequently, a large proportion of pregnant women continue to suffer silently with depression throughout their pregnancy. Given that depressive disorders among perinatal women are highly prevalent and may have profound impact on infants and children, more work is needed to enhance detection and referral.