University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon).
University of California San Francisco School of Medicine, San Francisco, CA (Ms Calthorpe); California Preterm Birth Initiative (Ms Baer, Dr Chambers, Mr Oltman, and Drs Rand, Jelliffe-Pawlowski, and Pantell); Department of Epidemiology and Biostatistics (Drs Chambers and Steurer, Mr Oltman, and Dr Jelliffe-Pawlowski); Department of Pediatrics (Drs Steurer, Karvonen, Rogers, and Pantell); Department of Obstetrics, Gynecology, and Reproductive Sciences (Dr Rand), University of California San Francisco, San Francisco, CA; Department of Pediatrics, University of California San Diego, La Jolla, CA (Ms Baer); University of California San Francisco School of Nursing, San Francisco, CA (Dr Shannon).
Am J Obstet Gynecol MFM. 2021 Jul;3(4):100380. doi: 10.1016/j.ajogmf.2021.100380. Epub 2021 Apr 28.
While mental health conditions such as postpartum depression are common, little is known about how mental healthcare utilization varies after term versus preterm delivery.
This study aimed to determine whether preterm birth is associated with postpartum inpatient and emergency mental healthcare utilization.
The study sample was obtained from a database of live-born neonates delivered in California between the years of 2011 and 2017. The sample included all people giving birth to singleton infants between the gestational age of 20 and 44 weeks. Preterm birth was defined as <37 weeks' gestation. Emergency department visits and hospitalizations with a mental health diagnosis within 1 year after birth were identified using International Classification of Diseases codes. Logistic regression was used to compare relative risks of healthcare utilization among people giving birth to preterm infants vs term infants, adjusting for the following covariates: age, race or ethnicity, parity, previous preterm birth, body mass index, tobacco use, alcohol or drug use, hypertension, diabetes mellitus, adequacy of prenatal care, education, insurance payer, and the presence of a mental health diagnosis before birth. Results were then stratified by mental health diagnosis before birth to determine whether associations varied based on mental health history.
Of our sample of 3,067,069 births, 6.7% were preterm. In fully adjusted models, compared with people giving birth to term infants, people giving birth to preterm infants had a 1.5 times (relative risk; 95% confidence interval, 1.4-1.7) and 1.3 times (relative risk; 95% confidence interval, 1.2-1.4) increased risk of being hospitalized with a mental health diagnosis within 3 months and 1 year after delivery, respectively. People giving birth to preterm infants also had 1.4 times (95% confidence interval, 1.3-1.5) and 1.3 times (95% confidence interval, 1.2-1.4) increased risk of visiting the emergency department for a mental health diagnosis within 3 months and 1 year after birth, respectively. Stratifying by preexisting mental health diagnosis, preterm birth was associated with an elevated risk of mental healthcare utilization for people with and without a previous mental health diagnosis.
We found that preterm birth is an independent risk factor for postpartum mental healthcare utilization. Our findings suggest that screening for and providing mental health resources to birthing people after delivery are crucial, particularly among people giving birth to preterm infants, regardless of mental health history.
虽然产后抑郁症等心理健康状况很常见，但人们对足月与早产分娩后心理健康保健的利用情况差异知之甚少。
本研究旨在确定早产是否与产后住院和急诊心理健康保健的利用有关。
本研究样本来自加利福尼亚州 2011 年至 2017 年期间活产新生儿的数据库。样本包括所有在妊娠 20 至 44 周之间分娩单胎婴儿的人群。早产定义为<37 周妊娠。通过国际疾病分类代码确定产后 1 年内的急诊就诊和精神卫生诊断住院情况。使用逻辑回归比较分娩早产儿与足月婴儿的医疗保健利用的相对风险，调整以下协变量：年龄、种族或民族、产次、既往早产、体重指数、吸烟、饮酒或吸毒、高血压、糖尿病、产前保健充足程度、教育、保险支付人以及产前是否存在精神卫生诊断。然后根据产前精神卫生诊断对结果进行分层，以确定关联是否因精神卫生史而异。
在我们的 3067069 例分娩样本中，有 6.7%为早产。在完全调整的模型中，与分娩足月婴儿的人群相比，分娩早产儿的人群在产后 3 个月和 1 年内因精神卫生诊断住院的风险分别增加了 1.5 倍（相对风险；95%置信区间，1.4-1.7）和 1.3 倍（相对风险；95%置信区间，1.2-1.4）。分娩早产儿的人群在产后 3 个月和 1 年内因精神卫生诊断急诊就诊的风险也分别增加了 1.4 倍（95%置信区间，1.3-1.5）和 1.3 倍（95%置信区间，1.2-1.4）。按既往精神卫生诊断分层，早产与有和没有既往精神卫生诊断的人群产后精神保健利用风险增加有关。
我们发现早产是产后精神保健利用的独立危险因素。我们的研究结果表明，产后对分娩人群进行精神健康筛查并提供精神健康资源至关重要，尤其是在分娩早产儿的人群中，无论其精神健康史如何。
