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

Abstract

Purpose: Severe maternal morbidity (SMM) may be associated with postpartum psychiatric morbidity. However, the direction and strength of this relationship remains unclear. Our goal was to estimate the association between SMM and postpartum inpatient mental health care utilization. Methods: We examined all liveborn deliveries at a large, safety-net hospital in Atlanta, Georgia, from 2013 to 2021. SMM at or within 42 days of delivery was identified using International Classification of Disease (ICD) codes. The primary outcome of interest was hospitalization with a psychiatric diagnosis in the year following delivery. We used inverse probability of treatment weighting based on propensity scores to adjust for demographics, index delivery characteristics, and medical, psychiatric, and obstetric history. We fit log binomial models with generalized estimating equations to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs). Results: Among 22,233 deliveries, the rates of SMM and postpartum hospitalization with a psychiatric diagnosis, respectively, were 6.8% (n = 1,149) and 0.8% (n = 169). The most common psychiatric diagnosis was non-psychotic mood disorders (without SMM 0.4%, n = 79; with SMM 1.7% n = 24). After weighting, 2.2% of deliveries with SMM had a postpartum readmission with a psychiatric diagnosis, compared to 0.7% of deliveries without SMM [aRR 3.2, 95% CI (2.0, 5.2)]. Associations were stronger among individuals without previous psychiatric hospitalization. Conclusion: Experiencing SMM was associated with elevated risk of postpartum psychiatric morbidity. These findings support screening and treatment for mild and moderate postpartum psychiatric disorders in the antenatal period.

Severe Maternal Morbidity and Mental Health Hospitalizations or Emergency Department Visits

“…Individuals who delivered after 43 weeks’ gestation and those younger than 18 or older than 55 years at delivery were excluded to optimize the accuracy of obstetric codes; individuals younger than 18 or older than 55 years were also excluded to account for unique mental health experience among pregnancies at extremes of age . As the interest was in new-onset mental health visits related to SMM, the primary analysis excluded individuals with a previous mental health hospitalization or ED visit within 2 years before the index birth, an approach that has been used previously . Duplicate delivery records, delivery records with missing identifiers, and individuals with ectopic pregnancy or miscarriage were also excluded.…”

“… 24 , 25 As the interest was in new-onset mental health visits related to SMM, the primary analysis excluded individuals with a previous mental health hospitalization or ED visit within 2 years before the index birth, an approach that has been used previously. 12 , 26 , 27 Duplicate delivery records, delivery records with missing identifiers, and individuals with ectopic pregnancy or miscarriage were also excluded. Therapeutic abortions and out-of-hospital deliveries were not available in the data source, but out-of-hospital deliveries account for less than 2% of deliveries in Canada.…”