Perinatal mental health and risk of severe maternal morbidity in women with physical disabilities, Massachusetts 2003-2015.

Abstract

Background: Perinatal mental health and substance use disorders contribute to adverse maternal outcomes. Women with disabilities experience increased risk for severe maternal morbidity (SMM). No studies have examined the association between perinatal mental health and SMM risk in women with physical disabilities.

Objective: To examine the association between perinatal mental health and substance use disorders and SMM risk in women with physical disabilities.

Methods: We analyzed delivery hospitalizations from 2003 to 2015 from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) data system. We identified physical disability using International Classification of Diseases, Ninth Revision codes. Perinatal mental health status was based on the presence of at least one emergency department visit, observational, or in-patient stay attributed to a mental health or substance use disorder anytime from gestation to delivery. We used modified Poisson regressions to obtain risk ratios (RR) for SMM in women with either a physical disability or no disability by perinatal mental health status. Non-disabled women with no perinatal mental health or substance use disorder visit served as the referent group.

Results: Deliveries in women with no physical disability and a perinatal mental health visit were not associated with risk of SMM. Compared to the referent group, women with a physical disability and a perinatal mental health or substance use disorder visit had greater risk of both SMM (RR = 1.84, 95 % CI:1.32-2.56), and nontransfusion SMM (RR = 2.35 1.52, 3.64), after adjusting for demographic and socioeconomic characteristics.

Conclusions: Increased attention should be paid to perinatal mental health status in women with physical disabilities.