Adverse pregnancy outcomes as predictors of postpartum psychiatric illness: a retrospective cohort study

Purpose
Severe maternal morbidity (SMM as defined by the Centers for Disease Control and Prevention) as well as other adverse pregnancy outcomes (APOs) may confer differential risk for postpartum psychiatric illness (PPI). PPI is often underrecognized, and it can have lasting and harmful effects on both the mother’s and the infant’s well-being. The purpose of this cross-sectional study is to explore whether specific pregnancy complications act as potential predictors for PPI, and how this differs across important social determinants of health (e.g. race/ethnicity).

Methods
Participant data was obtained from the electronic health record of patients (N = 19,231) who received perinatal care from HOSPITAL, a hospital system serving the most ethnically diverse large city in the United States, between 2020 and 2023. We utilized univariate and multivariate logistic regression models to obtain odds ratios for the associations desired.

Results
After accounting for premorbid psychiatric status, only APOs act as an independent predictor for the development of PPI within a year postpartum, and certain APOs are more closely associated with PPI depending on the mother’s racial/ethnic background. APOs were found to be strongly linked to PPI (OR = 1.43, CI 11.31–1.57, p < .001), specifically for non-Hispanic White women, Hispanic White women, and non-Hispanic Asian women.

Conclusions
Our findings highlight the need for a more proactive approach to screening, monitoring, and treatment in maternal mental healthcare, that would encompass both the specific APOs and the racial/ethnic differences associated with them.