Association Between Severe Maternal Morbidity and Psychiatric Illness Within 1 Year of Hospital Discharge After Delivery

Abstract

OBJECTIVE: To estimate whether severe maternal morbidity is associated with increased risk of psychiatric illness in the year after delivery hospital discharge. METHODS: This retrospective cohort study used International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes within Florida's Healthcare Cost and Utilization Project's databases. The first liveborn singleton delivery from 2005 to 2015 was included; women with ICD-9-CM codes for psychiatric illness or substance use disorder during pregnancy were excluded. The exposure was ICD-9-CM codes during delivery hospitalization of severe maternal morbidity, as per the Centers for Disease Control and Prevention. The primary outcome was ICD-9-CM codes in emergency department encounter or inpatient admission within 1 year of hospital discharge of composite psychiatric morbidity (suicide attempt, depression, anxiety, posttraumatic stress disorder, psychosis, acute stress reaction, or adjustment disorder). The secondary outcome was a composite of ICD-9-CM codes for substance use disorder. We compared women with severe maternal morbidity with those without severe maternal morbidity using multivariable logistic regression adjusting for sociodemographic factors and medical comorbidities. Cox proportional hazard models identified the highest risk period after hospital discharge for the primary outcome. RESULTS: A total of 15,510 women with severe maternal morbidity and 1,178,458 without severe maternal morbidity were included. Within 1 year of hospital discharge, 2.9% (n=452) of women with severe maternal morbidity had the primary outcome compared with 1.6% (n=19,279) of women without severe maternal morbidity, resulting in an adjusted odds ratio (aOR) 1.74 (95% CI 1.58–1.91). The highest risk interval was within 4 months of discharge (adjusted hazard ratio [adjusted HR] 2.53 [95% CI 2.05–3.12]). Most severe maternal morbidity conditions were associated with higher risk of postpartum psychiatric illness. Women with severe maternal morbidity had nearly twofold higher risk of postpartum substance use disorder (170 [1.1%] vs 6,861 [0.6%]; aOR 1.91 [95% CI 1.64–2.23]). CONCLUSION: Though absolute numbers were modest, severe maternal morbidity was associated with increased risk of severe postpartum psychiatric morbidity and substance use disorder. The highest period of risk extended to 4 months after hospital discharge.

The association between preterm birth and postpartum mental healthcare utilization among California birthing people

“…Emergency department visits and hospitalizations with a mental health diagnosis as the primary diagnosis within 1 year after birth were identified using International Classification of Diseases codes for visits (see Appendix), a commonly used measure of postpartum mental health. [35][36][37] Preexisting mental health diagnoses were identified based on the presence of these same ICD codes in an ED visit or hospitalization record prior to giving birth, or on the birth record.…”

Postpartum Psychiatric Outcomes following Severe Maternal Morbidity in an Urban Safety-Net Hospital

“…These results confirm and extend the results of prior research which showed elevated risk of inpatient psychiatric diagnoses among individuals with SMM compared to those without. 11 This study builds on prior research by using inverse probability of treatment weighting to balance baseline differences across exposure groups and including individuals with prior psychiatric history in the analysis. Though individuals with preexisting psychiatric conditions are at increased risk of exacerbation during the perinatal period, 19 data for patients with preexisting mental health conditions following adverse delivery events is limited.…”

“…We followed patients for 12 months following delivery from January 1, 2013 to May 31, 2021. Stillbirth has been independently associated with both SMM and postpartum psychiatric illness; 11 as such, we restricted the study population to live deliveries of one or more fetuses…”

Severe maternal morbidity and mortality during delivery hospitalization of class I, II, III, and super obese women

“…Obesity itself is associated with an increased odds of SMM and this is known to be associated with increasing rates of maternal mortality, increased hospital costs and increased length of stay (17). Emerging literature has also revealed that SMM may also be associated with increased risks of long term sequelae, specifically severe postpartum psychiatric diagnoses (24) Strengths and Limitations: This study has several strengths given its large size and ethnically and socioeconomically diverse, urban population. The size of our study sample created a robust database that allowed for comparisons between the classes of obesity and among SMM morbidities.…”