Mental Health
Pre-Pregnancy Mental Disorders as Risk Factors for Poor Perinatal Health Outcomes: An Exploratory Analysis Jeanine I. Nasser* Jeanine Nasser Yasmin Barrientos Kofman Jennifer A. Sumner Jaimie L. Gradus Samantha E. Parker
In the U.S., over 33% of childbearing people develop mental health symptoms in pregnancy. While untreated maternal mental health disorders (e.g., depression, anxiety) adversely affect postpartum maternal and child health, the impact of pre-pregnancy psychiatric disorders on perinatal health is unclear. Examining a spectrum of these conditions offers a new opportunity to elucidate how mental health impacts perinatal outcomes.
Data were from a retrospective electronic medical record (EMR)-based cohort study of 3925 deliveries at a safety net hospital from 2016-18. Analytic variables were ascertained using documented International Classification of Diseases, 10th Revision (ICD-10) codes in the EMR before the study pregnancy. Psychiatric diagnoses included depressive, manic/bipolar, anxiety stress, and substance use disorders (SUD). Perinatal outcomes included pregnancy-related maternal disorders, labor/delivery complications, and puerperium-related complications. Log-binomial regression was used to calculate crude RRs and RRs adjusted for maternal age at delivery, race, insurance type, and parity.
Although documented SUD did not confer increased risk of any perinatal outcomes, this observation was inconsistent across other psychiatric disorders. Documented bipolar/manic disorders were associated with higher risk of puerperium-related complications (aRR=1.3, 95% CI=1.1-1.6). Similarly, documented stress disorders were linked to heightened risk of pregnancy-related maternal disorders (aRR=1.2, 95% CI = 1.0-1.3), as were depressive disorders (aRR=1.1, 95% CI=1.0-1.3). Documented anxiety disorders were also associated with higher risk of labor/delivery complications (aRR=1.2, 95% CI=1.0-1.3).
Our findings indicate pre-pregnancy psychiatric diagnoses are associated with elevated risk for poor perinatal outcomes, though these findings vary across psychiatric disorders. Clinical intervention pre-pregnancy may have salient implications in improving maternal and child health.