Association between perinatal mental health and reproductive and neonatal complications: a retrospective birth cohort study

Background Maternal mental health as an important precursor to reproductive and neonatal complications remains understudied in the US, particularly in the Southeastern region, despite high medical costs and maternal morbidity, and infant burden. Objective This study sought to estimate the incidence of perinatal mental health disorders and the associated increased risk of leading pregnancy and infant complications. Methods A population-based retrospective birth cohort of delivery hospitalizations and readmissions was constructed for birthing populations in South Carolina, 1999 to 2017. Prevalence rates were calculated for perinatal mood and anxiety disorders (PMAD), severe mental illness (SMI), and maternal mental disorders of pregnancy (MDP). Poisson regression models using generalized estimating equations were used to estimate adjusted relative risks for the association between mental health conditions and severe maternal morbidity (SMM), hypertensive disorders of pregnancy (HDP), gestational diabetes (GD), cesarean delivery (CD), preterm birth (PTB), and low-birth weight (LBW). Results The most prevalent maternal mental condition was MDP (3.9%), followed by PMAD (2.7%) and SMI (0.13%). PMAD was associated with a higher risk of SMM, HDP, and CD, as well as a higher risk of PTB and LBW infants. SMI was associated with LBW, HDP, and CD. Pregnant populations with MDP were more at risk for SMM, PTB, HDP, LBW, and CD. Each maternal mental health outcome was associated with an elevated risk for hospital readmissions up to 45 days after delivery. Discussion Results demonstrated the escalating burden of PMAD and MDP for pregnant populations over time with important consequences related to maternal and infant morbidity.