Trends in and Complications Associated with Delivery Hospitalizations with Mental Health Condition Diagnoses

ABSTRACT BACKGROUND Mental health conditions during delivery hospitalizations are not well characterized. OBJECTIVE To characterize prevalence of maternal mental health condition diagnoses and associated risk during United States delivery hospitalizations METHODS The 2000-2018 Nationwide Inpatient Sample was used for this repeated-cross sectional analysis. Delivery hospitalizations to women age 15-54 with and without mental health condition diagnoses including depressive disorder, anxiety disorder, bipolar spectrum disorder, and schizophrenia spectrum disorder were identified. Temporal trends in mental health condition diagnoses during delivery hospitalizations were determined using the National Cancer Institute’s Joinpoint Regression Program to estimate the average annual percent change (AAPC) with 95% confidence intervals (CIs). Trends in chronic conditions associated with mental health condition diagnoses including asthma, pregestational diabetes, chronic hypertension, obesity, and substance use were analyzed. The association between mental health conditions and the following adverse outcomes was determined: i) severe maternal morbidity, (ii) preeclampsia or gestational hypertension, (iii) preterm delivery, (iv) postpartum hemorrhage, (v) cesarean delivery, and (vi) maternal mortality. Regression models for each outcome were performed with unadjusted (RR) and adjusted risk ratios as measures of effects. RESULTS Of 73,109,791 delivery hospitalizations, 2,316,963 (3.2%) had ≥1 associated mental health condition diagnosis. The proportion of delivery hospitalizations with a mental health condition increased from 0.6% in 2000 to 7.3% in 2018 (AAPC 11.4%, 95%CI 10.3%-12.6%). Among deliveries with a mental health condition diagnosis, chronic health conditions including asthma, pregestational diabetes, chronic hypertension, obesity, and substance use increased from 14.9% in 2000 to 38.5% in 2018. Deliveries with a mental health condition diagnosis were associated with severe maternal morbidity (RR 1.88, 95%CI 1.86-1.90), preeclampsia and gestational hypertension (RR 1.59, 95% CI 1.58, 1.60), preterm delivery (RR 1.35, 95%CI 1.35-1.36), postpartum hemorrhage (RR 1.37, 95%CI 1.36-1.38), cesarean delivery (RR 1.20, 95%CI 1.20-1.20), and maternal death (RR 1.31, 95%CI 1.12-1.56). Increased risk was retained in adjusted models. DISCUSSION The proportion of delivery hospitalizations with mental health condition diagnoses increased significantly over the study period. Mental health condition diagnoses are associated with other underlying chronic health conditions and a modest increased risk for a range of adverse outcomes. These findings suggest that mental health conditions are an important risk factor in adverse maternal outcomes.