Postpartum Psychiatric Outcomes following Severe Maternal Morbidity in an Urban Safety-Net Hospital Open Access

Abstract

Objective: To estimate the risk of hospitalization with a mental health disorder in the first postpartum year among patients with and without severe maternal morbidity (SMM) at a large, safety-net institution in Atlanta, Georgia.

Methods: In this population cohort study of majority publicly insured racial and ethnic minority patients, we examined all liveborn deliveries at Grady Memorial Hospital between January 1, 2013 and December 31, 2018. The exposure of interest was SMM at or within 42 days of delivery. The primary outcome was hospitalization with a psychiatric diagnosis in the year following delivery, identified using International Classification of Disease codes. We used inverse probability of treatment weighting based on propensity scores to adjust for index delivery characteristics, demographics, and medical, psychiatric, and obstetric history. We fit a log binomial model with generalized estimating equations to calculate adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for the association between SMM and risk of postpartum hospitalization with a psychiatric diagnosis.

Results: Among 16,984 deliveries, the overall rates of SMM and postpartum hospitalization with a mental health disorder, respectively, were 6.77% (n = 1149) and 0.68% (n = 115). The most common psychiatric diagnosis was non-psychotic mood disorders (with SMM 0.48%, n = 5; without SMM 0.37% n = 59). After adjusting for baseline differences, 1.12% of deliveries with SMM had a postpartum readmission within one year, compared to 0.65% (n = 102) of deliveries without SMM [aRR 1.65, 95% CI (0.94–2.90)].

Conclusion: Deliveries with SMM had higher rates of postpartum admission with psychiatric illness in the first postpartum year than deliveries without SMM. Patients who experience SMM at or within 42 days of delivery may benefit from enhanced psychosocial support in the critical year following delivery.

Table of Contents

I. Abstract

II. Introduction (pg. 1)

III. Methods (pg. 1)

IV. Results (pg. 4)

V. Discussion (pg. 6)

VI. Tables (pg. 9)

VII. References (pg. 13)

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology Health Sciences, Obstetrics and Gynecology
Keyword	social determinants of health health disparities psychiatric illness severe maternal morbidity perinatal perinatal psychiatric illness maternal morbidity maternal mental health psychiatric outcomes obstetric complications cohort study postpartum mental health
Committee Chair / Thesis Advisor	Jamieson, Denise, Emory University
Committee Members	Boulet, Sheree, Emory University

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