The risk of mental health hospitalization or emergency department (ED) visits up to 13 years post-delivery is increased in patients with severe maternal morbidity (SMM), according to a recent study published in JAMA Network Open.
Takeaways
- Severe maternal morbidity (SMM) during pregnancy, including conditions such as severe hemorrhage and septic shock, raises the risk of mental health issues post-delivery, as per a study in JAMA Network Open.
- Mental health concerns postpartum are a significant issue, with up to 36% of deaths within the first year linked to suicide, highlighting the importance of understanding the impact of SMM on mental well-being.
- Over a 13-year period, researchers found a notable association between SMM and mental health hospitalizations or emergency department visits, indicating the need for extended postpartum support and monitoring.
- The study included over 1.5 million patients, with 2.3% experiencing SMM, and found higher rates of mental health issues among those with SMM, particularly in mood and anxiety disorders and substance abuse.
- Recommendations from the study suggest enhanced mental health screening for individuals who experienced severe pregnancy complications, underscoring the necessity of holistic care for mothers beyond the immediate postpartum period.
Severe hemorrhage, severe preeclampsia or eclampsia, septic shock, and other life-threating conditions during pregnancy or the immediate postpartum period are referred to as SMM. These conditions have been associated with increased risks of chronic conditions such as cardiovascular disease, impaired functional ability, and pain.
Up to 36% of deaths within 1 year postpartum have been linked to suicide, making it vial to determine the impact of SMM on mental health. Therefore, investigators conducted a population-based cohort study to evaluate the association between SMM with mental health hospitalizations and ED visits over a 13-year period.
Patients aged 18 to 55 years with a live birth or stillbirth following a pregnancy of 20 to 43 weeks’ gestation from April 1, 2008, to March 31, 2021, were included in the analysis. Administrative, clinical, and demographic data was obtained from the Canadian Institute of Health Information (CIHI) Discharge Abstract Database (DAD).
The CIHI DAD data was linked to the National Ambulatory Care Reporting System dataset for ED information, with diagnostic codes captured using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canadian version.
Participants with SMM between 20 weeks’ gestation and 42 days post-delivery were considered exposed, while those without SMM were considered unexposed. Patients with a hospitalization or mental health visit within 2 years before birth were excluded from the analysis.
A composite of mental health hospitalization or ED visits from 43 days after index birth hospitalization onward was reported as the primary outcome of the analysis. Covariates included maternal age at delivery, delivery year, income quintile, maternal comorbid conditions, territory of delivery, hospital type, and urban or rural residential status.
There were 1,579,392 patients included in the analysis, 2.3% of whom had SMM. Patients with SMM were more often older, delivering in a teaching tertiary care hospital, and with preexisting conditions. Between the 2006 to 2007 and 2020 to 2021 periods, the SMM rate increased from 15.5 to 22.2 per 1000 deliveries.
Being hospitalized or visiting an ED for mental health concerns was reported among 43,066 individuals with recent childbirth, at a rate of 73.2 per 10,000 person-years. Rates included 59.2 per 10,000 person-years for mood and anxiety disorders and 17.1 per 10,000 person-years for substance abuse and related disorders.
Suicidality or self-harm had a rate of 4.8 per 10,000 person-years, and schizophrenia spectrum or other psychotic disorders a rate of 4.1 per 10,000 person-years. Mental health hospitalization or ED visit rates decreased with increasing age and income quintile and were highest in patients residing in rural areas or with 2 or more comorbid conditions.
A mental health hospitalization or ED visit was reported in 96.1 per 10,000 individuals among patients with SMM vs 72.7 per 10,000 among those without SMM. The median time to event among these groups was 2.8 years and 2.6 years, respectively.
All mental health factors except schizophrenia spectrum and other psychotic disorder had an increase in relative risk following SMM. The highest risk was for suicidality or self-harm, with an adjusted hazard ratio of 1.54.
These results indicated an association between SMM and hospitalization or ED visit for mental health conditions up to 13 years following delivery. Investigators recommended additional mental health screening in patients with severe pregnancy complications.
Reference
Blackman A, Ukah UV, Platt RW, et al. Severe maternal morbidity and mental mealth hospitalizations or emergency department visits. JAMA Netw Open. 2024;7(4):e247983. doi:10.1001/jamanetworkopen.2024.7983
