(358) Is severe maternal morbidity a risk factor for postpartum mental health hospitalization?

To examine rates of hospitalization with a mental health (MH) condition during the first year postpartum among patients with and without severe maternal morbidity (SMM) during delivery hospitalization.

Study Design: Data are from the Maryland’s State Inpatient Database and include patients with a delivery hospitalization during 2016-2019 (n=261,642). We compare rate of hospitalization with a MH diagnosis at 42 days and 42 days to 1 year postpartum by SMM status during the delivery hospitalization. We use multivariable logistic regression to examine hospitalization with a MH diagnosis (with and without substance use disorders) for patients by SMM status, adjusted for patient sociodemographic characteristics and presence of MH diagnosis during the delivery hospitalization. Analyses are also adjusted for clustering at the patient level for patients with multiple deliveries during the period of analysis. SMM and MH conditions are identified using ICD-10 diagnosis and procedure codes.

Results: Overall, 7,206 patients (2.8%) experienced rehospitalization in the year following delivery.  Among patients with rehospitalization, 25.5% (n=1,837) had a MH diagnosis. The rate of hospitalization with a MH diagnosis was 11.3 per 1,000 deliveries at 42 days postpartum and 23.2 at 42 days to 1 year postpartum for patients with SMM compared to 1.7 and 5.4 for patients without SMM during the delivery hospitalization. Patients with SMM had 3.7 times the odds (95% CI 2.8, 4.8) of hospitalization with a MH diagnosis during the first-year postpartum adjusting for age, race, median household income of zip code, primary insurance, urban residence, and the presence of a MH diagnosis during the delivery hospitalization (Table 1).

Conclusion: Patients who experience SMM have a higher odds of hospitalization with a MH diagnosis in the postpartum period. Treatment and support resource listing should be made available to patients upon discharge after delivery, and evidence-based interventions to improve MH should prioritize women with SMM.