Obstetric Complications in Women with Diagnosed Mental Illness: The Relative Success of California's County Mental Health System

Authors

  • Dorothy Thornton,

    1. Division of Community Health and Human Development, Berkeley School of Public Health, University of California, University Hall, Berkeley 415-596-6569, CA 94720
    Search for more papers by this author
    • Address correspondence to Dorothy Thornton, Ph.D., Assistant Adjunct Professor, Division of Community Health and Human Development, Berkeley School of Public Health, University of California, University Hall, Berkeley 415-596-6569, CA 94720; email: dthornto@berkeley.edu. Sylvia Guendelman, Ph.D., Professor and Chair, is with the Maternal and Child Health Program, Division of Community Health and Human Development, Berkeley School of Public Health, University of California, Berkeley, CA. Nap Hosang, M.D., M.P.H., M.B.A., Lecturer, is with Department of Obstetrics and Gynecology, Kaiser Permanente, School of Public Health, Hayward Medical Center, University of California, Berkeley, CA.

  • Sylvia Guendelman,

    1. Maternal and Child Health Program, Division of Community Health and Human Development, Berkeley School of Public Health, University of California, Berkeley, CA.
    Search for more papers by this author
  • Nap Hosang

    1. Department of Obstetrics and Gynecology, Kaiser Permanente, School of Public Health, Hayward Medical Center, University of California, Berkeley, CA.
    Search for more papers by this author

Abstract

Objective. To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness.

Data Source. Linked California hospital discharge (2000–2001), birth, fetal death, and county mental health system (CMHS) records.

Study Design. This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and clinical factors.

Results. Compared with deliveries in the general non–mentally ill population, deliveries to women with mental illness stand a higher adjusted risk of obstetric complication: AOR=1.32 (95 percent confidence interval [CI]=1.25, 1.39) for women treated in the CMHS and AOR=1.72 (95 percent CI=1.66, 1.79) for women not treated in the CMHS. Mentally ill women treated in the CMHS are at lower risk than non-CMHS mentally ill women of experiencing conditions associated with suboptimal intrapartum care (postpartum hemorrhage, major puerperal infections) and inadequate prenatal care (acute pyelonephritis).

Conclusion. Since mental disorders during pregnancy adversely affect mothers and their infants, care of the mentally ill pregnant woman by mental health and primary care providers warrants special attention.

Ancillary