Association Between Periviable Delivery and New Onset of or Exacerbation of Existing Mental Health Disorders

Abstract

Objective: To evaluate whether there is an association between periviable delivery and new onset of or exacerbation of existing mental health disorders within 12 months postpartum.

Methods: We conducted a retrospective cohort study of individuals with liveborn singleton neonates delivered at 22 or more weeks of gestation from 2008 to 2017 in the MarketScan Commercial Research Database. The exposure was periviable delivery , defined as delivery from 22 0/7 through 25 6/7 weeks of gestation. The primary outcome was a mental health morbidity composite of one or more of the following: emergency department encounter associated with depression, anxiety, psychosis, posttraumatic stress disorder, adjustment disorder, self-harm, or suicide; new psychotropic medication prescription; new behavioral therapy visit; and inpatient psychiatry admission in the 12 months postdelivery. Secondary outcomes included components of the primary composite. Those with and without periviable delivery were compared using multivariable logistic regression adjusted for clinically relevant covariates, with results reported as adjusted incident rate ratios (aIRRs). Effect modification by history of mental health diagnoses was assessed. Incidence of the primary outcome by 90-day intervals postdelivery was assessed.

Results: Of 2,300,244 included deliveries, 16,275 (0.7%) were periviable. Individuals with periviable delivery were more likely to have a chronic health condition, to have undergone cesarean delivery, and to have experienced severe maternal morbidity. Periviable delivery was associated with a modestly increased risk of the primary composite outcome, occurring in 13.8% of individuals with periviable delivery and 11.0% of individuals without periviable delivery (aIRR 1.18, 95% CI 1.12-1.24). The highest-risk period for the composite primary outcome was the first 90 days in those with periviable delivery compared with those without periviable delivery (51.6% vs 42.4%; incident rate ratio 1.56, 95% CI 1.47-1.66).

Conclusion: Periviable delivery was associated with a modestly increased risk of mental health morbidity in the 12 months postpartum.

Figure 1.

Study population. *A pregnancy may meet more than one exclusion criterion.

Figure 2.

Adjusted incident rate ratios for primary and secondary outcomes after periviable delivery including interaction with history of mental health diagnosis Emergency department (ED) Adjusted for delivery mode, maternal age, severe maternal morbidity (SMM), and maternal comorbidity index (MCI). P-value <0.002 considered statistically significant.

Figure 3.

Kaplan-Meier Curve for primary mental health composite outcome in the 12 months following delivery by 90-day intervals by periviable delivery Unadjusted Kaplan-Meier curves for the primary composite outcome by periviable delivery (PVD) and non-periviable delivery (Non-PVD) as time since delivery (Log rank test p<0.001). Shading represent 95% confidence intervals (CIs).