Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, USA.
Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.
BMC Womens Health. 2020 Jul 23;20(1):150. doi: 10.1186/s12905-020-00996-6.
National estimates of perinatal mood and anxiety disorders (PMAD) and serious mental illness (SMI) among delivering women over time, as well as associated outcomes and costs, are lacking. The prevalence of perinatal mood and anxiety disorders and serious mental illness from 2006 to 2015 were estimated as well as associated risk of adverse obstetric outcomes, including severe maternal morbidity and mortality (SMMM), and delivery costs.
The study was a serial, cross-sectional analysis of National Inpatient Sample data. The prevalence of PMAD and SMI was estimated among delivering women as well as obstetric outcomes, healthcare utilization, and delivery costs using adjusted weighted logistic with predictive margins and generalized linear regression models, respectively.
The study included an estimated 39,025,974 delivery hospitalizations from 2006 to 2015 in the U.S. PMAD increased from 18.4 (95% CI 16.4-20.0) to 40.4 (95% CI 39.3-41.6) per 1000 deliveries. SMI also increased among delivering women over time, from 4.2 (95% CI 3.9-4.6) to 8.1 (95% CI 7.9-8.4) per 1000 deliveries. Medicaid covered 72% (95% CI 71.2-72.9) of deliveries complicated by SMI compared to 44% (95% CI 43.1-45.0) and 43.5% (95% CI 42.5-44.5) among PMAD and all other deliveries, respectively. Women with PMAD and SMI experienced higher incidence of SMMM, and increased hospital transfers, lengths of stay, and delivery-related costs compared to other deliveries (P < .001 for all).
Over the past decade, the prevalence of both PMAD and SMI among delivering women increased substantially across the United States, and affected women had more adverse obstetric outcomes and delivery-related costs compared to other deliveries.
目前缺乏全国范围内关于围产期情绪和焦虑障碍（PMAD）和严重精神疾病（SMI）在产妇中的时间变化情况，以及相关结局和成本的估计。本研究旨在评估 2006 年至 2015 年期间围产期情绪和焦虑障碍以及严重精神疾病的患病率，以及与不良产科结局（包括严重孕产妇发病率和死亡率[SMMM]）和分娩成本相关的风险。
本研究为一项全国性住院患者样本的连续、横断面分析。使用调整后的加权逻辑预测边缘和广义线性回归模型，分别估计围产期妇女中 PMAD 和 SMI 的患病率以及产科结局、医疗保健利用和分娩成本。
本研究纳入了美国 2006 年至 2015 年期间估计有 39025974 例分娩住院患者。PMAD 从 18.4（95%CI 16.4-20.0）增加到 40.4（95%CI 39.3-41.6）/1000 例分娩。同时，随着时间的推移，产妇中 SMI 的比例也有所增加，从 4.2（95%CI 3.9-4.6）增加到 8.1（95%CI 7.9-8.4）/1000 例分娩。与 PMAD 和所有其他分娩相比，患有 SMI 的分娩中 Medicaid 覆盖比例为 72%（95%CI 71.2-72.9），分别为 44%（95%CI 43.1-45.0）和 43.5%（95%CI 42.5-44.5）。与其他分娩相比，患有 PMAD 和 SMI 的女性发生 SMMM 的比例更高，并且医院转科、住院时间和分娩相关费用也更高（所有 P<.001）。
在过去十年中，美国产妇中 PMAD 和 SMI 的患病率均大幅上升，与其他分娩相比，患有这些疾病的女性有更多的不良产科结局和分娩相关成本。
