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Epidemiology

Poster Session 1

(280) Joint Effects of Epilepsy and Mental Health on Severe Maternal Morbidity

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Mental illness and epilepsy are each associated with increased maternal morbidity and mortality, yet their joint effects are unknown. We evaluated the impact of concurrent mental illness on the relationship between epilepsy and non-transfusion severe maternal morbidity (SMM).

Study Design: We conducted a population-based cohort study of birth certificate (both live birth and fetal death) and hospital discharge records in California in 2007-2018. Epilepsy and mental health disorders at delivery hospitalization were identified using ICD-CM codes. Mental health disorders included depression, anxiety, bipolar disorder, post-traumatic stress disorder, and psychosis/delusions. Exposures were no epilepsy or mental health disorder (referent), mental health disorder alone, epilepsy alone, or both epilepsy and mental health disorder. The outcome was SMM—defined as presence of 1 of 20 indicators not including blood transfusion—during delivery hospitalization or hospitalization within 6-weeks postpartum. The associations between exposure groups and SMM were modeled by multivariable logistic regression, adjusting for age, race/ethnicity, education, delivery payment, initiation of prenatal care, delivery BMI, and parity.

Results: 5,275,994 people were included. The prevalence of mental health disorder without epilepsy was 296 patients per 10,000, epilepsy without a mental health disorder was 28 per 10,000, and epilepsy with mental health disorder was 5 per 10,000. Within these groups, there was higher incidence of SMM (1.75%, 3.00%, 4.15%) compared to the referent group (SMM: 0.77%). Logistic regression showed increased odds of SMM with each respective diagnosis compared to the referent group. Patients with both epilepsy and mental health disorder had highest odds of SMM (aOR 4.91 (95% CI 4.01,6.00) Figure 1). An interaction term of epilepsy and mental health disorder on SMM was significant (p=0.005).

Conclusion: Independently, epilepsy and mental health disorders were confirmed as drivers of maternal morbidity. Patients with both diagnoses carried even higher odds of experiencing SMM during delivery or postpartum.