Prior psychiatric inpatient care and risk of cesarean sections: a registry study

Abstract

This study of 17,443 childbearing women, investigated the relationship between hospital admissions 5 years prior to index birth, type of mental disorders and risk factors for mode of delivery. Hospital based electronic perinatal medical records between 2001 and 2006, were linked with the Swedish National Inpatient Care Registry 1996–2006. Of all the women, 39.3% had had inpatient care prior to index birth (27.3% had had obstetric, 10.1% somatic, and 1.9% psychiatric inpatient care). Diagnoses of mental disorders at psychiatric admission (n = 333) were categorized into five groups: personality/behavioral/unspecified disorder (30.9%), affective disorders and ‘suicide attempt’ (28.9%), neurotic/somatoform disorders (18.9%), substance use (17.1%) and schizophrenia (4.2%). Women with history of psychiatric care were more often smokers, below age 24 and single (p < 0.001, respectively), had more markers of mental ill-health in pregnancy records (p ≤ 0.001), compared to women without such previous care, and fewer were nulliparous (p < 0.001). The results show that women with prior psychiatric inpatient care and those with identified mental ill-health in pregnancy records, were associated with increased adjusted risks of cesarean sections. Identifying a woman’s mental health status in pregnancy may predict and prevent emergency cesarean section.

Keywords::

• cesarean section
• inpatient care
• psychiatric
• registry study
• risk

Acknowledgements

We thank the Department of Obstetrics and Gynecology at the Scania University Hospital, Malmö, for allowing us to access the KIKA™ system.

Declaration of Interest: Funding was by grant provided by the Faculty of Health and Society, Malmö University, Sweden.

Current knowledge

• Mental health problems and disorders in childbearing women are common and continue to increase.

• Psychiatric illness in pregnancy can affect the health of both the mother and the newborn child in the postpartum period.

• Studies investigating the effects between prior inpatient care, mental disorders and ill-health in pregnancy and risk of CS are inconclusive.

What this study adds

• A high prevalence of childbearing women had had a history of inpatient care, including psychiatric admissions, within a 5-year window prior to index birth.

• Women with a history of psychiatric admissions had an increased adjusted risk of CS.

• High prevalence of markers of mental ill-health identified from perinatal medical records was present in women with a history of psychiatric inpatient care.

• Women self-reporting such markers of mental ill-health in pregnancy had an increased risk of emergency CS.