Trends in and complications associated with mental health condition diagnoses during delivery hospitalizations

Logue, Teresa C.; Wen, Timothy; Monk, Catherine; Guglielminotti, Jean; Huang, Yongmei; Wright, Jason D.; D’Alton, Mary E.; Friedman, Alexander M.

doi:10.1016/j.ajog.2021.09.021

Cited by 22 publications

(17 citation statements)

References 39 publications

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“…The prevalence rate increased from approximately 1 in 1997 to 1136 patients during the 4-year study period. Logue et al 15 recently demonstrated a 10-fold increase in delivery hospitalizations with 1 or more mental health diagnoses from 2000 to 2018. Although Logue et al 15 did not assess PTSD diagnoses and this study excluded these conditions, the rise in other mental health disorders validates the findings here.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Association of severe maternal morbidity and post-traumatic stress disorder

Duval

Youssefzadeh

Sweeney

et al. 2022

AJOG Global Reports

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Section: Resultsmentioning

confidence: 99%

“…Mental health conditions that were excluded were depressive disorder, bipolar spectrum disorder, schizophrenia spectrum disorder, anxiety disorder, acute stress reaction, and adjustment disorder. 15 Excluded substance use disorders were tobacco use, alcohol use, and drug use.…”

Section: Methodsmentioning

confidence: 99%

Association of severe maternal morbidity and post-traumatic stress disorder

Duval

Youssefzadeh

Sweeney

et al. 2022

AJOG Global Reports

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“…Previous literature has demonstrated associations between PPH and mental health disorders. 25 There are various explanations as to why mothers with a pre-existing mental health disorder may develop PPH. This patient population is at increased risk for metabolic issues, such as obesity, which may have a modest effect on PPH risk.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis of complications associated with postpartum hemorrhage up to 1 year postpartum in mothers with and without a pre-existing mental health diagnosis

Endres,

Razavi,

Tian

et al. 2023

Womens Health (Lond Engl)

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Background/objectives: There is limited research on the associated immediate and long-term outcomes of postpartum hemorrhage. Mothers with a pre-existing psychiatric disease prior to delivery may be especially vulnerable to postpartum hemorrhage outcomes but little is known on this topic. Barriers to studying this population exist and add to knowledge gaps. The goal of this study is to determine the clinical characteristics and frequency of complications within 1 year of a postpartum hemorrhage diagnosis and the psychiatric sequelae within 7 days of a postpartum hemorrhage diagnosis in mothers with a pre-existing mental health diagnosis prior to delivery versus those without. Methods/design: This is a multicenter retrospective observational cohort study using TriNetX, a de-identified electronic health record database. The following electronic health record data were collected and evaluated in postpartum females who were billed for either a vaginal or cesarean delivery: age, race, ethnicity, diagnostic codes, medication codes, and number of deaths. Results: We included 10,649 subjects (6994 (65.7%) no mental health diagnosis and 3655 (34.3%) pre-existing mental health diagnosis). Haloperidol administration (118 (3.2%) versus 129 (1.8%), p < 0.001) was more prevalent in subjects with a pre-existing mental health diagnosis. Adjusting for demographics, pre-existing mental health diagnoses were associated with complications within 1 year after postpartum hemorrhage diagnosis (OR = 1.39, 95% CI: 1.26–1.52, p < 0.001). Conclusion: Having a mental health disorder history is associated with a higher odds of developing subsequent complications within 1 year of postpartum hemorrhage diagnosis. Mothers with a pre-existing mental health disorder have a significantly higher frequency of certain severe postpartum hemorrhage sequelae, including acute respiratory distress syndrome, retained placenta, sickle cell crisis, and need for mechanical ventilation/tracheostomy up to 1 year after delivery. Medications such as haloperidol were ordered more frequently within 7 days of a postpartum hemorrhage diagnosis in these mothers as well. Further research is needed to understand and manage the unique consequences of postpartum hemorrhage in this vulnerable maternal population.

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“…All hospital deliveries, both vaginal deliveries and cesarean sections, in pregnant patients aged 15–54 years between January 2016 and December 2019 were abstracted from the dataset. The age cutoffs were based on recent studies 12,13 . The World Health Organization's International Classification of Disease 10th edition (ICD‐10) Clinical Modification codes were used to define the presence of adenomyosis as well as delineate additional diagnoses and procedures performed within the index hospital admission.…”

Section: Methodsmentioning

confidence: 99%

The association between uterine adenomyosis and adverse obstetric outcomes: A propensity score‐matched analysis

Mandelbaum

Melville

Violette

et al. 2023

Acta Obstet Gynecol Scand

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Introduction This study examined obstetric outcomes in patients diagnosed with uterine adenomyosis. Material and methods This historical cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was all hospital deliveries in women aged 15–54 years between January 2016 and December 2019. The exposure was a diagnosis of uterine adenomyosis. The main outcome measures were obstetric characteristics, including placenta previa, placenta accreta spectrum, and placental abruption. Secondary outcomes were delivery complications including severe maternal morbidity. Analytic steps to assess these outcomes included (i) a 1‐to‐N propensity score matching to mitigate and balance prepregnancy confounders to assess obstetric characteristics, followed by (ii) an adjusting model with preselected pregnancy and delivery factors to assess maternal morbidity. Sensitivity analyses were also performed with restricted cohorts to account for prior uterine scar, uterine myoma, and extra‐uterine endometriosis. Results After propensity score matching, 5430 patients with adenomyosis were compared to 21 720 patients without adenomyosis. Adenomyosis was associated with an increased odds of placenta accreta spectrum (adjusted‐odds ratio [aOR] 3.07, 95% confidence interval [CI] 2.01–4.70), placenta abruption (aOR 3.21, 95% CI: 2.60–3.98), and placenta previa (aOR 5.08, 95% CI: 4.25–6.06). Delivery at <32 weeks of gestation (aOR 1.48, 95% CI: 1.24–1.77) and cesarean delivery (aOR 7.72, 95% CI: 7.04–8.47) were both increased in women with adenomyosis. Patients in the adenomyosis group were more likely to experience severe maternal morbidity at delivery compared to those in the nonadenomyosis group (aOR 1.86, 95% CI: 1.59–2.16). Results remained robust in the aforementioned several sensitivity analyses. Conclusions This national‐level analysis suggests that a diagnosis of uterine adenomyosis is associated with an increased risk of placental pathology (placenta accreta spectrum, placenta abruption, and placental previa) and adverse maternal outcomes at delivery.

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Trends in and complications associated with mental health condition diagnoses during delivery hospitalizations

Cited by 22 publications

References 39 publications

Association of severe maternal morbidity and post-traumatic stress disorder

Association of severe maternal morbidity and post-traumatic stress disorder

A retrospective analysis of complications associated with postpartum hemorrhage up to 1 year postpartum in mothers with and without a pre-existing mental health diagnosis

The association between uterine adenomyosis and adverse obstetric outcomes: A propensity score‐matched analysis

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