Associations between inpatient psychiatric admissions during pregnancy and adverse obstetric and birth outcomes

Am J Obstet Gynecol MFM. 2021 May 31;100413. doi: 10.1016/j.ajogmf.2021.100413. Online ahead of print.

Abstract

Background: Previous research supports an association between psychiatric diagnoses and adverse obstetric and neonatal outcomes including low birth weight, preterm birth, and preeclampsia. Women who are admitted for inpatient psychiatric care are regarded as having more acute illnesses than those who are able to be managed as outpatients. Prior research has not yet investigated how the severity of psychiatric illness, as indicated by type of antenatal psychiatric care received, is associated with adverse obstetric outcomes.

Objective: This study examines if rates of adverse birth and obstetric outcomes vary with the type of antenatal psychiatric care received when psychiatric care is indicated.

Study design: Using a retrospective, observational design, information from women who gave birth between January 1, 2006 and December 31, 2016 was captured from electronic medical records. Women were grouped as follows: (1) received antepartum inpatient psychiatric treatment (n=148), (2) documented psychiatric history without antepartum inpatient treatment (n=301), and (3) no documented psychiatric history or antepartum treatment (n=301). Linear and logistic regression predicted the odds of birth and obstetric outcomes including gestational age at birth, birth weight, mode of delivery, time to delivery, preterm premature rupture of membranes, meconium-stained amniotic fluid, and 5-minute Apgar score. Measured covariates included maternal age, race, parity, body mass index, maternal medical comorbidities, smoking tobacco, gestational age at first prenatal visit, and psychotropic medication use during pregnancy.

Results: Women with a psychiatric history, despite type of antepartum psychiatric care received, had higher rates of adverse outcomes as compared with women without documented psychiatric history. However, women who received antepartum inpatient psychiatric care had longer gestational lengths, 38.05 ± 3.0 versus 37.19 ± 4.23 weeks (P<0.05) and gave birth to heavier babies, 3047.84 ± 591.99 versus 2906.48 ± 851.85 g (P<0.01) than women with a psychiatric history who did not receive antepartum inpatient care even when adjusting for measured covariates.

Conclusions: Receiving antepartum inpatient psychiatric care may promote positive birth outcomes for women with acutely severe psychiatric conditions.

Keywords: Inpatient psychiatric care; maternal mental health; neonatal outcomes; obstetric outcomes; psychiatric illness.