Severe maternal morbidity raises risk for mental health hospitalizations, ED visits

Key takeaways:

• Women with vs. without severe maternal morbidity had higher risk for mental health hospitalizations or ED visits.
• Risk was greatest during the first year postpartum.

Severe maternal morbidity was associated with increased risk for mental health hospitalization or emergency department visit up to 13 years postpartum, according to a population-based Canadian cohort study published in JAMA Network Open.

“Studies of associations between various adverse pregnancy events and postpartum mental health outcomes have principally examined specific conditions, like preeclampsia, or have relatively short follow-up periods,” Asia Blackman, MSc, perinatal epidemiologist in the department of epidemiology, biostatistics and occupational health at McGill University, Montreal, and colleagues wrote. “Furthermore, very few studies have been completed within Canada, which has a multiethnic population with universal antenatal health coverage yet variable access to postpartum mental health services.”

Blackman and colleagues conducted a population-based retrospective cohort study using data from 1,579,392 postpartum women (mean age, 30 years) aged 18 to 55 years with complete ED and hospital records. All women had a first hospital childbirth from 2008 to 2021 in 11 provinces and territories in Canada. Researchers defined severe maternal morbidity as a composite of septic shock, severe preeclampsia or eclampsia, severe hemorrhage with intervention or other complications occurring after 20 weeks gestation and up to 42 days postpartum.

Primary outcome was a mental health hospitalization or ED visit due to mood and anxiety disorders, substance use, schizophrenia or other psychotic disorders or suicidality or self-harm occurring at least 43 days postpartum, the researchers reported.

Overall, 2.3% of women had severe maternal morbidity. After a median of 2.6 years, 1,287 women with severe maternal morbidity had a mental health hospitalization or ED visit compared with 41,779 women without (96.1 vs. 73.2 per 10,000 person-years, respectively; adjusted HR = 1.26; 95% CI, 1.19-1.34). The median time to event was 2.8 years for women with severe maternal morbidity and 2.6 years for women without.

Women with severe maternal morbidity had the highest RR for a mental health hospitalization or ED visit during the first year postpartum (aHR = 1.38; 95% CI, 1.24-1.53).

Hospitalization or ED visit frequencies for individual mental health diagnoses per 10,000 person-years were 59.2 for mood and anxiety disorders, 17.1 for substance abuse, 4.8 for suicidality or self-harm and 4.1 for schizophrenia or other psychotic disorders. Researchers observed the greatest risk for hospitalizations or ED visits among women with self-harm events (aHR = 1.54; 95% CI, 1.26-1.88). Risk for mental health hospitalizations or ED visits was highest for women with embolism, shock and disseminated intravascular coagulation (aHR = 1.71; 95% CI, 1.38-2.12).

“These findings suggest that individuals who experience severe pregnancy complications may benefit from additional mental health screening,” the researchers wrote.