Severe Maternal Morbidity Associated with Mental Health Risks Post-Delivery: Daily Dose

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Last week, we reported on findings from a study published in JAMA Network Open that examined the association between severe maternal morbidity (SMM) in the first recorded birth and the risk of hospitalization or emergency department (ED) visits for a mental health condition over a 13-year period.

The study

Researchers conducted a population-based retrospective cohort study using data from postpartum individuals aged 18 to 55 years with a first hospital delivery between 2008 and 2021 in 11 provinces and territories in Canada.

Investigators obtained administrative, clinical, and demographic data on all deliveries from the Canadian Institute of Health Information (CIHI) Discharge Abstract Database (DAD). The CIHI DAD data were linked to the National Ambulatory Care Reporting System dataset for participant data from EDs. Individuals with a mental health hospitalization or ED visit within 2 years of the index birth were excluded.

Exposure was occurrence of SMM between 20 weeks’ gestation and 42 days post-delivery. The research team defined a composite of mental health hospitalization or ED visits from 43 days after index birth hospitalization and beyond as the primary outcome of interest. Covariates included maternal age at delivery, delivery year, income quintile, maternal comorbidities, Canadian territory of delivery, hospital type, and urban or rural residential status.

The research team developed models for 3 follow-up periods: up to 1 year, 1 to 5 years, and more than 5 years, to assess how proximity to delivery might modify the association between SMM and mental health hospitalization or ED visit.

The findings

The final cohort for the analysis numbered 1 579 392 participants with a mean age of approximately 30 years; 2.3% had SMM.

Of the original cohort, investigators reported 43 066 individuals with recent childbirth were either hospitalized or visited an ED for mental health concerns, a rate of 73.2 per 10 000 person-years (PY). The rate for mood and anxiety disorders was reported as 59.2/10 000 PY and for substance abuse and related disorder as 17.1/10 000 PY.

Among study participants with an experience of SMM, investigators reported a mental health hospitalization or ED visit in 96.1 per 10 000 compared with 72.7 per 10 000 among those without SMM (HR, 1.31, 95% CI, 1.24-1.39; aHR, 1.26, 95% CI, 1.19-1.34).

Individuals with SMM had the highest relative risk of hospitalization or ED visit for a mental health condition in the first year post-partum (aHR, 1.38, 95% CI, 1.24-1.53). And, although dissipated somewhat over time, results showed risk persisted for those with more than 1 year but fewer than 5 years follow-up (1.23, 95% CI 1.14-1.34), and for those with more than 5 years of follow-up (1.21, 95% CI, 1.07-1.37).

Authors' comment

"These findings suggest that individuals who experience severe pregnancy complications may benefit from additional mental health screening."

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