Wolfson Carrie L, Angelson Jessica Tsipe, Creanga Andreea A
Johns Hopkins Bloomberg School of Public Health.
Res Sq. 2024 Jul 23:rs.3.rs-4655614. doi: 10.21203/rs.3.rs-4655614/v1.
Perinatal mental health conditions and substance use are leading causes, often co-occurring, of pregnancy-related and pregnancy-associated deaths in the United States. This study compares odds of hospitalization with a mental health condition or substance use disorder or both during the first year postpartum between patients with and without severe maternal morbidity (SMM) during delivery hospitalization.
Data are from the Maryland's State Inpatient Database and include patients with a delivery hospitalization during 2016-2018 (n = 197,749). We compare rate of hospitalization with a mental health condition or substance use disorder or both at 42 days and 42 days to 1 year postpartum by occurrence of SMM during the delivery hospitalization. We use multivariable logistic regression to derive the odds of hospitalization with each outcome for patients by SMM status, adjusted for patient sociodemographic characteristics, presence of mental health condition or substance use disorder diagnoses during the delivery hospitalization, and delivery outcome. SMM, mental health conditions, and substance use disorders are identified using ICD-10 diagnosis and procedure codes.
Overall, 5,793 patients (2.9%) who delivered during 2016-2018 experienced hospitalization in the year following delivery. Among these patients, 24.3% (n = 1,410) had a mental health condition diagnosis, 10.6% (n = 619) had a substance use disorder diagnosis, and 9.8% (n = 570) had co-occurring mental health condition and substance use disorder diagnoses. Patients with SMM had 3.7 times the odds (95% CI 2.7, 5.2) of hospitalization with a mental health condition diagnosis, 2.7 times the odds (95% CI 1.6, 4.4) of a hospitalization with substance use disorder diagnosis, and 3.0 times the odds (95% CI 1.8, 4.8) of hospitalization with co-occurring mental health condition and substance use disorder diagnoses during the first-year postpartum adjusting for covariates.
Patients who experience SMM during their delivery hospitalization had higher odds of hospitalization with a mental health condition, substance use disorder, and co-occurring mental health condition and substance use disorder in the one-year postpartum period. Treatment and support resources for mental health and substance use providers --including enhanced screening and warm handoffs -- should be made available to patients with SMM upon discharge after delivery, and evidence-based interventions to improve mental health and reduce substance use should be prioritized in these patients.
围产期心理健康状况和物质使用是美国与妊娠相关及妊娠合并死亡的主要原因，且常同时出现。本研究比较了分娩住院期间患有和未患有严重孕产妇发病（SMM）的患者在产后第一年因心理健康状况、物质使用障碍或两者而住院的几率。
数据来自马里兰州住院患者数据库，包括2016 - 2018年期间分娩住院的患者（n = 197,749）。我们根据分娩住院期间SMM的发生情况，比较产后42天以及产后42天至1年因心理健康状况、物质使用障碍或两者而住院的比例。我们使用多变量逻辑回归来计算按SMM状态划分的患者出现每种结局而住院的几率，并对患者的社会人口学特征、分娩住院期间心理健康状况或物质使用障碍诊断的存在情况以及分娩结局进行调整。SMM、心理健康状况和物质使用障碍通过国际疾病分类第十版（ICD - 10）诊断和程序代码进行识别。
总体而言，2016 - 2018年期间分娩的5,793名患者（2.9%）在分娩后一年内住院。在这些患者中，24.3%（n = 1,410）有心理健康状况诊断，10.6%（n = 619）有物质使用障碍诊断，9.8%（n = 570）有心理健康状况和物质使用障碍共病诊断。在调整协变量后，患有SMM的患者因心理健康状况诊断而住院的几率是未患SMM患者的3.7倍（9
