Neonatal Outcomes and Mental Illness, Substance Abuse, and Intentional Injury During Pregnancy

Abstract

Mental illness (MI), substance abuse (SA), and intentional injury (II) are known individual risk factors for adverse pregnancy outcomes. Their combined association with preterm birth (PTB) and low birth weight (LBW) remains relatively unexplored. We examined hospital utilization for the co-occurrence of II and MI or SA in pregnant women in Massachusetts and assessed their interactive association with PTB and LBW. This retrospective cohort study used ICD-9 and E-codes reported on linked birth and hospital utilization data to identify MI, SA, and II diagnoses during pregnancy for 176,845 Massachusetts resident women who delivered during 2002-2004. Adjusted odds ratios (OR) for the independent and joint associations of MI, SA, and II on PTB and LBW were calculated. Two thousand two hundred and eight women (1.6%) had a prenatal MI visit, 834 (0.5%) a prenatal SA visit, and 847 (0.5%) a prenatal II visit. Among them 163 women had MI and II visits and 69 had SA and II visits. SA, MI, and II were all significant predictors of LBW and PTB. Women with both SA and II had higher odds of PTB (OR 2.7 95% CI 1.3-5.7) and LBW (OR 5.3 95% CI 3.9-7.3) than women with neither diagnosis. Prenatal MI, SA, and II are risk factors for LBW and PTB. Women with SA and II co-diagnoses have greater risk of LBW and PTB than women with neither diagnosis. Screening, timely diagnosis, and treatment of women with co-occurring morbidities, particularly II and SA, should be incorporated into reproductive and perinatal health programs.

Avaliação de desfechos perinatais/infantis em partos de pacientes com transtornos mentais maiores de um hospital psiquiátrico do Rio de Janeiro, Brasil

“…Esses estudos também revelaram que tais prevalências foram significativamente mais elevadas nessas mães quando comparadas com a população em geral 7,10,13,18,19 .…”

“…Essas pesquisas apontam como principais fatores associados à elevada frequência de desfechos adversos nas gestações de mães com transtornos mentais maiores o uso de álcool, tabaco e outras substâncias psicoativas, as precárias condições socioeconômicas de vida e de cuidados no pré-natal e o uso de psicofármacos durante a gravidez 7,10,13,18 .…”

Preconception Women’s Health and Pediatrics: An Opportunity to Address Infant Mortality and Family Health

“…Considerable evidence demonstrates the impact of baseline maternal health (eg, diabetes, cardiovascular diseases, depression) and behaviors (eg, smoking, drug use, nutrition) on child and adult outcomes. 9–14 The story of folic acid supplementation is a powerful example of how a preconception intervention influences child health. The educational campaign and fortification of grains led to a 26% decrease in the rate of neural tube defects.…”

The relationship between sleep and postpartum mental disorders: A systematic review

“…Postpartum mental illness can also have a significant adverse effect on neonatal outcomes, such as low birth weight, decreased fetal growth and preterm birth (Apter et al, 2011;Dayan et al, 2002;Hoffman and Hatch, 2000;Kelly et al, 2002;MacCabe et al, 2007;Misri and Kendrick, 2007;Orr et al, 2002;Rogal et al, 2007;Steer et al, 1992;Wiencrot et al, 2012). These disorders can negatively impact infant development and health, as well as the health of other family members (Apter et al, 2011;Bacchus et al, 2004;Barnett et al, 1993;Campbell et al, 1995;Civic and Holt, 2000;Murray and Cooper, 1997;O'Connor et al, 2002).…”