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CME Credit Offered
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Poster Session 3

(686) Association of periviable birth and postpartum psychiatric morbidity in the Medicaid population

Friday, January 31, 2025
10:30 AM – 12:30 PM  
Objective: Publicly insured patients have increased risk of adverse obstetric outcomes and perinatal psychiatric morbidity. Although periviable birth is a significantly stressful obstetric event, its association with postpartum psychiatric outcomes has not been studied in this high-risk population.

Study Design: Singleton liveborn periviable births (22 0/7 to 25 6/7 weeks) vs non-periviable births (≥26 0/7 weeks) were identified using claims data in the Merative MarketScan Medicaid database from 2020-2022. The primary outcome was a composite of psychiatric morbidity, defined as one or more of the following within 12 months postpartum: emergency department (ED) or outpatient encounters associated with depression, anxiety, psychosis, posttraumatic stress disorder, adjustment disorder, self-harm, or suicide attempt; new psychotropic medication prescription; or inpatient psychiatry admission. Analysis was adjusted for maternal age, cesarean delivery (CD), severe maternal morbidity (SMM), maternal comorbidity index, and history of mental health disorder.

Results: Out of 639,971 deliveries, there were 3,518 (0.5%) periviable births (PB) and 636,453 non-periviable births (NPB) included for analysis. Baseline prevalence of mental health disorders was similar between groups. The incidence of SMM, hypertensive disorders of pregnancy, and CD was higher among individuals with PB. Compared to NPB, PB was associated with greater incidence of composite psychiatric morbidity (27.3% vs 22.5%, aOR 1.32 [95% CI 1.22-1.42]) and increased ED utilization for mental health disorders (5.1% vs 3.9%, aOR 1.37 [95% CI 1.17-1.60]); furthermore, patients with PB were more than twice as likely to have postpartum inpatient psychiatric admission (5.8% vs 2.8%, aOR 2.26 [95% CI 1.95-2.62]). PB was associated with increased incidence of new psychotropic medication prescriptions and outpatient behavioral health visits.

Conclusion: Despite increased outpatient behavioral healthcare utilization, p</span>ublicly insured patients who experience periviable birth are at high risk for psychiatric morbidity requiring emergency or inpatient-level of care.