Pregnancies and births in women with several of the most serious types of mental illness face an increased risk of gestational, obstetric and fetal health complications, according to a recently published study by a multidisciplinary team of investigators from departments across USC and Children's Hospital Los Angeles (CHLA). 

Ashwini Lakshmanan, MD, MPH

The study demonstrates an association between serious mental illness (SMI) and maternal and fetal health that has long been recognized by clinicians but incompletely elucidated in research, explained Ashwini Lakshmanan, MD, MPH, Attending Neonatologist at CHLA and Assistant Professor of Clinical Pediatrics at Keck School of Medicine of USC.

"We have known more generally that serious mental illness is an issue for mothers and babies, but this is one of the first papers to take a broad, composite look at the health risks faced by women with serious mental illness and to start understanding what the epidemiology looks like," said Lakshmanan. Serious mental illness comprises such conditions as bipolar disorders, schizophrenia and major depressive disorders.

SMI and comorbidities.

The topic is complex in part because of the comorbidities found at higher rates in people with SMI, among them obesity, diabetes and substance use problems.

"We were examining access to mental health care for people with serious mental illness but we came across a gap in the literature regarding pregnant women," said first author Hanke Heun-Johnson, PhD, a research associate at USC Leonard D. Schaeffer Center for Health Policy & Economics. "The previous studies in this area tended to look at the connection between serious mental illness and low birth weight, but we did not really find papers that comprehensively controlled for comorbidities that often present in people with serious mental illness."

In fact, the paper found that such comorbidities are responsible for about half of the excess risk of complications for mothers with serious mental illnesses and their newborns, explained Lakshmanan and Heun-Johnson.

The researchers drew their data from several years of maternal delivery records in the Healthcare Cost and Utilization Project Nationwide/National Inpatient Sample, the largest all-payer database publically available in the United States, which captures data on the vast majority of births in the country. The investigators needed the notably large number of birth records available in the nationwide database to capture a large enough sample with SMI.

The additional risk for mothers with SMIs and their babies resulted in additional days in the hospital and an average of about $3,100 more in hospital charges, compared with mothers who did not have one of the diagnoses of serious mental illness. 

Long-term health impacts for children.

Of greater concern are the long-term impacts of adverse birth outcomes for the children. "The elevated rate of adverse outcomes has lifelong implications for children of mothers with SMI," the authors wrote. "One of the most prevalent adverse outcomes, preterm birth, has been associated with long-term health issues, such as visual, hearing, speech, neuromotor, cognitive, and behavioral impairments, and cerebral palsy." Other potential harms of adverse birth outcomes included cardiovascular disorders and neurological deficits.

Lakshmanan took part in the study as part of her KL2 researcher training mentorship at the Southern California Clinical and Translational Science Institute. Lakshmanan recently completed the KL2 program. She is also a Fellow at the Schaeffer Center.

The paper, "Association between maternal serious mental illness and adverse birth outcomes," was published in the Journal of Perinatology in March 2019. Other authors were Seth A. Seabury, PhD; Michael Menchine, MD, MPH; Ilene Claudius, MD; and Sarah Axeen PhD.

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