Original articleMaternal psychiatric disorders and risk of preterm birth
Introduction
Maternal psychiatric disorders are common among women of childbearing age [1], [2], [3]. During pregnancy, up to 10% and 13% have depression and anxiety disorder, respectively, whereas 3% have bipolar disorder and less than 1% have psychotic disorders [4], [5]. Women with untreated psychiatric disorders are less likely to access care, including prenatal care, and may be more prone to substance abuse before and during pregnancy [6]. Treatment of maternal psychiatric disorders during pregnancy requires consideration, including the severity of the maternal condition, the medication to be used, and the potential effects of the medication on the mother and the fetus [7], [8]. Although pregnancy is considered a vulnerable period for psychiatric disorders, most of the focus in the literature is on the postpartum period [5], [9], [10].
In 2012, 11.5% of infants in the United States were born preterm at less than 37 weeks' gestation [11]. Preterm neonates are at higher risk of morbidity and mortality as well as increased risk for psychiatric disorders later in life [12], [13]. Pregnant women with any psychiatric disorder have a shorter gestational length [14] and are at increased risk for preterm birth [15], [16], [17], [18]. One previous study has shown that the associations between preterm birth and maternal psychiatric morbidity seemed to be independent of familial relationships and measured covariates [19].
However, data on specific psychiatric disorders and preterm birth risk are less consistent. The risk of preterm birth has been associated with maternal depression or antidepressant use during pregnancy in some [20], [21], [22], [23], [24] but not all studies [25], [26], [27]. A recent study suggests that underlying psychiatric disorders might confound the association between antidepressant use and preterm birth, as women who received selective serotonin reuptake inhibitors had lower risk of preterm birth than women with psychiatric disorders without exposure to these medications [28]. Findings are somewhat less inconsistent between maternal anxiety disorders and preterm birth risk [29], whereas maternal schizophrenia and bipolar disease are more consistently associated with preterm births [30], [31]. The effect of comorbid maternal psychiatric disorders is seldom studied.
In our study from a large, contemporary pregnant U.S. population, we investigated the effect of a full range of maternal psychiatric disorders, including comorbid psychiatric conditions on odds of preterm birth.
Section snippets
Methods
The Consortium on Safe Labor (2002–2008, with 87% of births occurring 2005–2007) was an observational nationwide U.S. cohort including 12 clinical centers with 19 hospitals, chosen due to their geographic distribution and the availability of electronic medical records [32]. The study included 228,668 women with 233,844 newborns (including multiples) [32]. We excluded 230 deliveries because of errors of identification and all multifetal pregnancies (n = 5044), rendering a final sample size of
Results
Altogether, 16,398 of pregnancies (7.3%) were affected by one or more maternal psychiatric disorder. Prevalence of individual disorders among pregnant women was 3.7% depression, 0.3% anxiety, 0.2% bipolar disorder, 0.1% bipolar disorder with depression and/or anxiety, 0.1% schizophrenia, and 2.5% unspecified. Women with psychiatric disorders were somewhat younger and heavier and were more often non-Hispanic white and not married. They were less likely to have private insurance or to be
Discussion
In this study from a large contemporary pregnancy cohort from the United States, we found that all maternal psychiatric disorders were associated with increased odds of delivery less than 39 weeks' gestation, including odds of preterm birth less than 37, less than 34, and less than 28 weeks' gestation. Maternal comorbid psychiatric disorders, especially depression with anxiety seemed to pose the highest risks for shorter gestational length and preterm birth, although the odds ratio estimates
Acknowledgments
Institutions involved in the consortium include, in alphabetical order: Baystate Medical Center, Springfield, Massachusetts; Cedars-Sinai Medical Center Burnes Allen Research Center, Los Angeles, California; Christiana Care Health System, Newark, Delaware; Georgetown University Hospital, MedStar Health, Washington, D.C.; Indiana University Clarian Health, Indianapolis, Indiana; Intermountain Healthcare and the University of Utah, Salt Lake City, Utah; Maimonides Medical Center, Brooklyn, New
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2022, Journal of the American Academy of Child and Adolescent PsychiatryCitation Excerpt :Although not statistically significant, this finding suggests the need for further study of the relationship of familial genetic loading and psychiatric illness. Other authors have reported that mothers with any psychiatric disorder are at heightened risk of having a preterm born infant.58 Therefore, future work should focus on determining which first-degree relative had a psychiatric disorder and examining the association with psychiatric outcomes in preterm born individuals while accounting for other confounds associated with psychiatric disorders in mothers and with preterm births in offspring.