Abstract
BACKGROUND: Mental disorders are highly prevalent during pregnancy and are associated with unfavorable obstetrical outcomes, including maternal mortality. This study examined specific and combined associations of mental disorders with maternal morbidities. METHODS: A cross-sectional study of all delivery hospitalizations between the ages of 12-55 years was conducted using the National Inpatient Sample data from 2017. The International Classification of Diseases-10 codes were used to define exposures including depressive, anxiety, post-traumatic stress (PTSD), sleep, and bipolar disorders, and outcomes including premature rupture of membranes (PROM), hydramnios, placental disorder, cesarean delivery, fetal death, preterm birth, and postpartum hemorrhage (PPH). Survey-weighted logistic regression analysis was conducted to evaluate the associations between mental disorders and obstetric outcomes after adjusting for age, race/ethnicity, household income, primary payer, smoking, alcohol use, substance use, and obesity. RESULTS: The analysis of 715,810 delivery hospitalizations, representing 3,579,046 deliveries in the US demonstrates that sleep disorder is associated with PROM (OR = 1.41; 95% CI: 1.13, 1.75), placental disorder (OR = 1.56; 95% CI: 1.24, 1.95), cesarean delivery (OR = 1.50; 95% CI: 1.36, 1.65), and PPH (OR = 1.36; 95% CI: 1.10, 1.68) to a greater extent than other mental disorders. However, depressive disorder is greatly associated with hydramnios (OR = 1.16; 95% CI: 1.08, 1.25) and fetal death (OR = 1.38; 95% CI: 1.18, 1.61), while PTSD (OR = 1.40; 95% CI: 1.19, 1.64) is associated with preterm birth than other mental disorders. CONCLUSIONS: Most mental disorders are independently associated with critical obstetric outcomes, with the extent of associations depending on specific obstetric outcomes. The study findings indicate the need for mandatory screening and management of mental health conditions in routine obstetrical care to improve maternal and child health outcomes.