Hospital Outcomes in Antepartum Mental Disorders: A Study on 897,397 Pregnant Inpatients

Abstract

Objective: To evaluate the impact of antepartum mental disorders (AMD) in medical and psychiatric comorbidities, and inpatient outcomes during hospitalizations for pregnancy/birth-related complications. Methods: We used the national inpatient sample (NIS) data and included 19,170,562 female patients (age, 12–40 years) with a principal diagnosis of pregnancy/birth-related complications and grouped by co-diagnoses of AMD (N = 897,397). We used a binomial logistic regression model to evaluate the odds ratio (OR) for major severity of illness and adjusted for demographic confounders. Results: The hospitalizations with AMD increased by 22.1% (p < 0.001) from 2010 to 2014. White females (66.1%) and those from low-income families (<25th percentile, 31.8%) majorly had comorbid AMD. Depression (43.8%) and drug abuse (27%) were prevalent psychiatric disorders in AMD inpatients. Comorbid AMD inpatients had a higher likelihood for major severity of illness (OR 2.475, 95% CI 2.459–2.491, p < 0.001). They also had a longer hospitalization stay with a mean difference of 0.486 days (95% CI 0.480–0.491) and higher total charges by $1889.420 per admission (95% CI 1852.670–1926.170) than non-AMD inpatients. Conclusions: AMD is associated with worsening of severity of illness in pregnancy/birth-related complications and require acute inpatient care. Mental health assessment and treatment of AMD, and education about efficacy and safety of psychiatric medications may help to improve outcomes in these patients.

Demographics and Hospital Outcomes in American Women With Endometriosis and Psychiatric Comorbidities

“…Psychiatric comorbidities were most common in white women of reproductive age between 26 and 45 years and from lower socioeconomic status, which is in line with previous research on women with antepartum mental disorders [ 19 ]. Reproductive age in women is a time where the menstrual cycle is actively maximizing the symptoms of endometriosis given the repetitive and consistent nature of the menstrual cycle.…”

“…In our study, we found that there was statistically no significant difference in the utilization of gynecological procedures during hospitalization for endometriosis by the presence of psychiatric comorbidities. However, females with psychiatric comorbidities had significantly longer hospital LOS and higher total charges, which is in line with past inpatient and outpatient studies [ 19 , 26 ]. Past literature also states that psychiatric comorbidities increase the LOS for medical and surgical inpatients, in addition to gynecological inpatients, and increases medical costs leading to more systemic burden on inpatient care [ 27 , 28 ].…”

“…There are few limitations of this study being conducted using the administrative database as there is a lack of patient-level clinical information. Yet, the NIS is an excellent population-based representation of diseases related to systematic and temporal factors and has been used in past studies on women's mental health [ 19 , 29 ]. The major strength of this data is the large sample with national representation of the population through a uniform collection of patient records through ICD-9 codes.…”

Antepartum Drug Dependence and Pregnancy- or Birth-related Complications: A Cross-sectional Study of 19 Million Inpatients

“…A nationwide study found that antepartum mental disorders are associated with increased LOS and higher inpatient charges by USD 1,889 [8]. Similarly, we found that pregnant inpatients with ADD had an extended LOS and higher total charges by USD 3,797.…”

“…Opioid use during pregnancy leads to dreadful complications including respiratory depression, microcephaly, and sudden infant death syndrome [2,7]. A nationwide inpatient study found that one-third of the patients with antepartum mental disorders hospitalized for pregnancy-related complications abused drugs [8].…”