Trends in and complications associated with mental health condition diagnoses during delivery hospitalizations
Trends in and complications associated with mental health condition diagnoses during delivery hospitalizations
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DOI：
10.1016/j.ajog.2021.09.021
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发表时间：
2022-03-05
影响因子：
9.8
通讯作者：
Friedman, Alexander M.
中科院分区：
文献类型：
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作者：
Logue, Teresa C.;Wen, Timothy;Friedman, Alexander M.
背景：分娩住院期间的心理健康状况尚未得到很好的描述。目的：本研究旨在描述美国分娩住院期间孕产妇心理健康状况诊断的患病率和相关风险。研究设计：2000 年至 2018 年全国住院患者样本用于重复横断面分析。研究人员确定了 15 至 54 岁之间有或没有诊断出精神健康状况（包括抑郁症、焦虑症、躁郁症谱系障碍和精神分裂症谱系障碍）的女性的分娩住院情况。使用美国国家癌症研究所的连接点回归计划来确定分娩住院期间精神健康状况诊断的时间趋势，以估计年平均百分比变化（95% 置信区间）。分析了与心理健康状况诊断相关的慢性疾病的趋势，包括哮喘、孕前糖尿病、慢性高血压、肥胖和药物滥用。确定了心理健康状况与以下不良后果之间的关联：（1）严重孕产妇发病率，（2）先兆子痫或妊娠期高血压，（3）早产，（4）产后出血，（5）剖腹产，（6）孕产妇死亡率。每个结果的回归模型均以未调整和调整的风险比作为效果衡量指标。结果：在 73,109,791 例分娩住院中，2,316,963 例 (3.2%) 具有 >= 1 项相关心理健康状况诊断。患有精神健康问题的住院分娩比例从 2000 年的 0.6% 增加到 2018 年的 7.3%（年平均百分比变化，11.4%；95% 置信区间，10.3%-12.6%）。在诊断为精神健康状况的女性中，患有慢性健康状况（包括哮喘、孕前糖尿病、慢性高血压、肥胖和药物滥用）的分娩比例从 2000 年的 14.9% 增加到 2018 年的 38.5%。诊断为精神健康状况的女性的分娩与严重的孕产妇发病率相关（风险比，1.88；95% 置信区间，1.86-1.90），先兆子痫和妊娠期高血压（风险比，1.59；95% 置信区间，1.58-1.60）、早产（风险比，1.35；95% 置信区间，1.35-1.36）、产后出血（风险比，1.37；95% 置信区间，1.36-1.38）、剖宫产（风险比，1.35；95% 置信区间，1.36-1.38） 1.20；95% 置信区间，1.20-1.20）和孕产妇死亡（风险比，1.31；95% 置信区间，1.12-1.56）。调整后的模型中保留了增加的风险。结论：在整个研究期间，诊断出精神健康状况的分娩住院比例显着增加。心理健康状况诊断与其他潜在的慢性健康状况有关，并且一系列不良后果的风险略有增加。研究结果表明，心理健康状况是不良孕产妇结局的重要危险因素。
BACKGROUND: Mental health conditions during delivery hospitalizations are not well characterized.OBJECTIVE: This study aimed to characterize the prevalence of maternal mental health condition diagnoses and associated risk during delivery hospitalizations in the United States.STUDY DESIGN: The 2000 to 2018 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of women aged 15 to 54 years with and without mental health condition diagnoses, including depressive disorder, anxiety disorder, bipolar spectrum disorder, and schizophrenia spectrum disorder, were identified. Temporal trends in mental health condition diagnoses during delivery hospitalizations were determined using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% confidence intervals. The trends in chronic conditions associated with mental health condition diagnoses, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, were analyzed. The association between mental health conditions and the following adverse outcomes was determined: (1) severe maternal morbidity, (2) preeclampsia or gestational hypertension, (3) preterm delivery, (4) postpartum hemorrhage, (5) cesarean delivery, and (6) maternal mortality. Regression models for each outcome were performed with unadjusted and adjusted risk ratios as measures of effects.RESULTS: Of 73,109,791 delivery hospitalizations, 2,316,963 (3.2%) had >= 1 associated mental health condition diagnosis. The proportion of delivery hospitalizations with a mental health condition increased from 0.6% in 2000 to 7.3% in 2018 (average annual percent change, 11.4%; 95% confidence interval, 10.3%-12.6%). Among deliveries in women with a mental health condition diagnosis, chronic health conditions, including asthma, pregestational diabetes mellitus, chronic hypertension, obesity, and substance use, increased from 14.9% in 2000 to 38.5% in 2018. Deliveries to women with a mental health condition diagnosis were associated with severe maternal morbidity (risk ratio, 1.88; 95% confidence interval, 1.86-1.90), preeclampsia and gestational hypertension (risk ratio, 1.59; 95% confidence interval, 1.58-1.60), preterm delivery (risk ratio, 1.35; 95% confidence interval, 1.35-1.36), postpartum hemorrhage (risk ratio, 1.37; 95% confidence interval, 1.36-1.38), cesarean delivery (risk ratio, 1.20; 95% confidence interval, 1.20-1.20), and maternal death (risk ratio, 1.31; 95% confidence interval, 1.12-1.56). The increased risk was retained in adjusted models.CONCLUSION: The proportion of delivery hospitalizations with mental health condition diagnoses increased significantly throughout the study period. Mental health condition diagnoses were associated with other underlying chronic health conditions and a modestly increased risk of a range of adverse outcomes. The findings suggested that mental health conditions are an important risk factor in adverse maternal outcomes.