Association between maternal serious mental illness and adverse birth outcomes

H Heun-Johnson; S A Seabury; M Menchine; I Claudius; S Axeen; A Lakshmanan

doi:10.1038/s41372-019-0346-5

Association between maternal serious mental illness and adverse birth outcomes

J Perinatol. 2019 May;39(5):737-745. doi: 10.1038/s41372-019-0346-5. Epub 2019 Mar 8.

Authors

H Heun-Johnson^{1

2}, S A Seabury^{3

4}, M Menchine^{3

5}, I Claudius⁶, S Axeen^{3

5}, A Lakshmanan^{3

7

8}

Affiliations

¹ Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA. heunjohn@usc.edu.
² Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA. heunjohn@usc.edu.
³ Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA.
⁴ Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, USA.
⁵ Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁶ Department of Emergency Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁷ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁸ Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Abstract

Objective: To evaluate the contribution of serious mental illness (SMI) and specific risk factors (comorbidities and substance use) to the risk of adverse birth outcomes.

Study design: This cross-sectional study uses maternal delivery records in the Healthcare Cost and Utilization Project Nationwide/National Inpatient Sample (HCUP-NIS) to estimate risk factor prevalence and relative risk of adverse birth outcomes (e.g., preeclampsia, preterm birth, and fetal distress) in women with SMI.

Results: The relative risk of adverse gestational (1.15, 95% CI: 1.13-1.17), obstetric (1.07, 1.06-1.08), and fetal (1.24, 1.21-1.26) outcomes is increased for women with SMI. After adjusting for risk factors, the risk is significantly reduced but remains elevated for all three adverse outcome categories (gestational: 1.08, 1.06-1.09; obstetric: 1.03, 1.02-1.05; fetal: 1.12, 1.09-1.14).

Conclusions: Maternal serious mental illness is independently associated with increased risk for adverse birth outcomes. However, approximately half of the excess risk is attributable to comorbidities and substance use.

Publication types

Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Cross-Sectional Studies
Databases, Factual
Female
Fetal Distress / epidemiology*
Gestational Age
Humans
Infant, Newborn
Length of Stay / economics
Logistic Models
Mental Disorders / epidemiology*
Mothers / psychology
Multivariate Analysis
Pre-Eclampsia / epidemiology*
Pregnancy
Pregnancy Complications / epidemiology
Pregnancy Outcome*
Premature Birth / epidemiology*
Risk Factors
United States / epidemiology

Grants and funding

KL2 TR001854/TR/NCATS NIH HHS/United States