Research

Dr. Lindsay Admon led this research to assess the trends in suicidal ideation and intentional self-harm in a large national cohort of commercially insured childbearing individuals.

Findings: In this serial cross-sectional analysis of 595 237 childbearing individuals 1 year before and after giving birth, suicidal ideation and intentional self-harm increased significantly between 2006 and 2017. Non-Hispanic Black individuals, those with low-income, and younger individuals as well as those with comorbid anxiety, depression, or other serious mental illness had larger escalations.

Meaning: Clinical and policy interventions for addressing this health crisis should be tailored to meet the unique needs of childbearing individuals in the year before and following birth, particularly among high-risk groups.

Melissa Zochowski led this project on primary Cesarean section trends among women with and without PMADs, in a commercially insured US population from 2007-2018.

Findings: The predicted probability of a C-section was on average 3.5% higher for women with PMADs than those without them (95% CI: 2.7, 4.3). Annual C-section rates fell during the study period for both groups, with rates decreasing from 26.8% in 2008 to 21.8% in 2017 for the PMAD group, and from 23.2% in 2008 to 18.2% in 2017 for the group without PMAD diagnoses.

Meaning: PMADs were associated with higher rates of primary C-section in a population of women otherwise at low risk for delivery by C-section. This finding extends what is known about the relationship between these disorders and a critical birth outcome, implicating that primary C-sections may be an important negative birth income to include in future analyses of women with PMADs who are otherwise at low risk for delivery by C-section.

Dr. Lindsay Admon published a research letter entitled, “Comparison of Delivery-Related, Early and Late Postpartum Severe Maternal Morbidity Among Individuals With Commercial Insurance in the US, 2016 to 2017.”

Findings: Higher rates of Severe Maternal Morbidity (SMM) with transfusion occurred among Black individuals compared to White individuals for the pregnancy, early postpartum, and late postpartum periods. Higher rates of SMM with transfusion were also seen in individuals with PMADs compared to those without PMADs in each of the three periods.

Meaning: Black individuals and individuals with PMADs experienced a markedly sustained risk for SMM early and late postpartum, which should inform clinical and policy strategies to address and prevent maternal morbidity and mortality among these populations.

Drs. Rebecca Haffajee, Laura Faherty, and Kara Zivin published a perspective article in the New England Journal of Medicine on state-level punitive and reporting policies on substance use disorders during pregnancy.

Findings: For childbearing individuals with commercial insurance in the United States, the prevalence of substance use disorders (SUDs), SUDs cooccurring with maternal mental health conditions, and SUDs cooccurring with suicidality all increased from 2006 to 2017. During the same time, there was a steady increase in the number of States with punitive and reporting policies on the detection of substance use during pregnancy.

Meaning: Amid increasing rates of behavioral health conditions in this population, persistent adverse maternal health outcomes, and the Covid-19 pandemic (during which overdose deaths have spiked), we need policies that draw women into care and help them recover, not policies that push them away from care and into the criminal justice system. Punishing pregnant women with SUDs has been ineffective; we believe it’s time to prioritize approaches that support pregnant women and their families.

Dr. Dana Beck, now with UCLA, led this work on how a NICU admission and its duration affects maternal mental health (MMH) diagnoses.

Findings: Women whose infants became hospitalized in the NICU for <2 weeks had 19% higher odds of maternal MH diagnoses and those whose infants became hospitalized for >2 weeks had 37% higher odds of maternal MH diagnoses compared to those whose infants did not have a NICU hospitalization. Compared to white women, all other race/ethnicities had significantly lower odds of receiving a maternal MH condition diagnosis despite higher rates of NICU hospitalization.

Meaning: These findings suggest a need to target the NICU to improve maternal MH screening, services, and support while acknowledging the influence of social determinants, including race and ethnicity, on health outcomes.

Dr. Karen Tabb with the University of Illinois Urbana-Champaign led a paper with our group on antenatal depression and suicidal ideation diagnoses among US pregnant people under commercial insurance policies.

Findings: Rates (95 % CIs) of depression increased by 39 % from 540 (520-560) per 10,000 individuals in 2008 to 750 (730-770) per 10,000 individuals in 2018. Suicidal ideation increased by 100 % from 15 (12-18) per 10,000 individuals in 2008 to 44 (39-50) per 10,000 individuals in 2018. Black birthing people experiencing the sharpest proportional increases.

Meaning: The prevalence of depression and suicidal ideation occurring during pregnancy substantially increased over a ten-year period. Further, suicidal ideation diagnosis increased the most for among Black birthing people compared to all groups, resulting in a need for future studies in this area to determine the reasons for an increase in diagnosis and any change in resulting treatment of follow up.