123: Is severe intrapartum maternal morbidity associated with acute psychiatric illness within a year of delivery?

Abstract

The impact of severe maternal morbidity (SMM) on postpartum psychiatric health is unknown. We aimed to determine whether women without preexisting psychiatric illness have higher odds of developing severe psychiatric morbidity in the year after term, singleton livebirth with versus without SMM. This retrospective cohort study used the Florida State Inpatient and State Emergency Department (ED) Databases. The first delivery of all Florida residents aged 13 to 55 years old from 2005 to 2013 was included; women with pre-existing psychiatric illness were excluded. ICD-9-CM diagnosis codes identified SMM (per CDC composite) and psychiatric conditions from nine months prior to delivery (for exclusion) until one year after delivery. The primary outcome was presentation to the ED or hospital within a year of delivery for severe psychiatric morbidity (composite of suicide attempt, depression, anxiety, post-traumatic stress disorder, acute stress reaction, or adjustment disorder) or substance use (drug or alcohol use or dependence). Secondary outcomes included psychiatric morbidity with individual measures of the SMM composite. We compared outcomes after term, singleton liveborn delivery with SMM versus without SMM using multivariable logistic regression adjusting for mode of delivery and maternal age, race, health insurance type, and income quartile. 16,698 women with SMM and 1,190,882 without SMM were included. Within a year of delivery with SMM, 3.0% of women had severe psychiatric morbidity: the odds were over two times higher compared to delivery without SMM (adjusted odds ratio (aOR) 2.04 (95% Confidence Interval (CI) 1.86 – 2.24)). SMM was associated with significantly higher odds of having individual conditions within the psychiatric composite, particularly adjustment disorder (aOR 2.80 (95% CI 1.99 – 3.94)) & depression (aOR 2.22 (95% CI 1.95 – 2.53)). Within the SMM composite, having acute myocardial infarction, acute renal failure, conversion of cardiac arrhythmia, sepsis, sickle cell crisis, & tracheostomy each had more than four times higher odds of severe psychiatric morbidity within a year of delivery compared to women who did not have these conditions. SMM during term, singleton delivery is associated with increased risk of severe psychiatric illness in the following year, particularly for certain morbidities. Women who have SMM may benefit from additional psychosocial support for at least a year after delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)