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

Racial disparities in emergency mental healthcare utilization among birthing people with preterm infants

“…We suspect that part of the reason the results became insignificant in this group is that sample sizes for healthcare events became very small. These findings are consistent with previous literature indicating PTB as a risk factor for healthcare utilization 14 and suggest the need for mental health support for families with preterm infants of all GA.…”

“…We thought it prudent to expand on this work by investigating whether disparities also exist for birthing people of color who have delivered infants prematurely, because PTB and its complications also have been associated with poor mental health and increased mental healthcare utilization. 14 , 24 The Chan et al 24 study was restricted to birthing people with postpartum depression, whereas our study considered other important mental health conditions, which require a different approach to diagnosis and treatment, faced by birthing people like anxiety, bipolar disorder, schizophrenia, behavioral conditions, personality disorders, and not otherwise specified mental health conditions for a more complete understanding of mental health and severe mental healthcare utilization in this population. In addition, we controlled for infant characteristics like degree of prematurity (<32 vs 32–36 weeks’ gestation) and infant birthweight among preterm infants because prematurity and birthweight have been identified previously as risk factors for mental health conditions.…”

“…PTB may exacerbate postpartum mental health symptoms and existing disparities in postpartum mental healthcare in several ways. 12 – 14 For example, preterm infants are at high risk for major preterm comorbidities, unexpected complications requiring procedures and/or surgeries, compromised neurodevelopment impairment, technology dependence and disability, and mortality. 25 Long hospitalizations and complications of PTB can contribute to financial hardships for families.…”

“… 13 In addition, giving birth prematurely is a stressful life event that can exacerbate mental health conditions and has been shown to be associated with inpatient mental healthcare utilization postpartum including both emergency department (ED) visits and hospitalizations. 14 …”

“…Although previous work has examined disparities in ED and hospital utilization after giving birth to both term and preterm infants, 24 we specifically chose to focus on preterm infants, because PTB and its complications have also been associated with poor mental health and increased mental healthcare utilization. 14 , 24 In addition, although previous work has focused more specifically on postpartum depression, 24 we elected in this study to examine all mental health conditions including but not limited to mood disorders (depression, bipolar disorder), anxiety related disorders (posttraumatic stress disorder, generalized anxiety disorder), and schizophrenia. Because birthing people of color are a unique population at high risk for PTB, poor infant outcomes, mental health conditions, and mental healthcare utilization, we hypothesized racial and ethnic disparities also exist in mental health-related ED visits and hospitalizations among a population of birthing people who delivered infants preterm.…”