Severe maternal morbidity and mental health-related hospitalizations or emergency department visits after delivery: A nation-wide study in Canada
Bibliographic record
Abstract
Background: Severe maternal morbidity (SMM) is a composite of near-fatal events occurring during pregnancy or the puerperium. SMM is known to cause significant physical and emotional trauma, resulting in both short-term and long-term health complications. Short term psychological complications of SMM range from depressive symptoms to psychiatric admission or prescription medication for mental illness. SMM subtypes like severe pre-eclampsia have been associated with long term outcomes of severe mental illness, including psychiatric admission for depression. It is plausible that composite SMM is also associated with long-term severe mental health outcomes, including mental-health related hospitalization or emergency department visits. Objectives and hypotheses: The primary objective is to assess for an association between any SMM in the first recorded birth, with hospitalization or ED visit for mental illness up to 13 years after the index birth hospitalization, as compared to no SMM in the first recorded birth. Methods: Using data from the Canadian Institute of Health Information Discharge Abstract Database (DAD) and the National Ambulatory Care Reporting System (NACRS) we performed a longitudinal cohort study of 2,112,518 Canadian postpartum individuals aged 18-55 years with a first recorded hospital birth between April 1, 2008 and March 31, 2021. The primary study outcome was a composite of mental health-related hospitalization and/or ED visits occurring 43 days or more after the index birth hospitalization. The composite was defined by an ICD-10-CA code for a mood or anxiety disorder, substance-related or addictive disorder, schizophrenia spectrum or other psychotic disorder, or suicidality or self-harm event We used univariable and multivariable Cox regression models to generate crude and adjusted hazard ratios (HRs).Results: A total of 2,112,518 individuals gave birth over the study period; after exclusions, our analytic cohort included 35,825 SMM-affected individuals and 1,543,567 were non SMM-affected individuals (mean age 29.7±5.4 and 30.7 ±6.0, respectively). SMM-affected individuals were more likely to be older, to deliver pre-term, to have a stillbirth, to have a cesearean section, and to have experienced a non-severe hypertensive disorder of pregnancy or gestational diabetes compared with individuals who did not have an SMM. Overall, 43,066 individuals had a mental health-related hospitalization or ED visit (73.2 per 10 000); among these, 1287 had a recorded SMM (96.1 per 1000), and 41 779 did not (72.7 per 1000) (crude HR 1.31 [95% CI 1.24-1.39]). After adjustment for delivery year, comorbidity, maternal age, urban or rural residential status and income quintile, the adjusted HR was 1.26 (95% 1.19-1.34.Conclusion: Results from this study suggest a relationship between composite SMM and long-term mental health-related hospitalization or ED visit. As pregnancy complications become increasingly prevalent in Canada, it is increasingly crucial to understand the association between these events and adverse mental health outcomes. Given the disruptive nature of severe obstetric complications, and the potential for long-term mental health complications, it is important to extend clinical monitoring for these conditions among postpartum individuals beyond the first year postpartum
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.008 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".