BACKGROUND
Up-to-date data on population-level risk factors for postpartum psychosis is limited,
although increasing substance use disorders, psychiatric disorders, autoimmune disorders,
and other medical comorbidities in the obstetrical population may be contributing
to the increased baseline risk of postpartum psychosis.
OBJECTIVE
This study aimed to determine trends in and risk factors for postpartum psychosis
during delivery hospitalizations and postpartum readmissions.
STUDY DESIGN
Analyzing the 2016–2019 Nationwide Readmission Database, this repeated cross-sectional
study identified diagnoses of postpartum psychosis during delivery hospitalizations
and postpartum readmissions within 60 days of discharge. The relationship among demographic,
clinical, and hospital-level factors present at delivery and postpartum psychosis
was analyzed with logistic regression models with adjusted odds ratios with 95% confidence
intervals as measures of association. Separate models were created for postpartum
psychosis diagnoses at delivery and during postpartum readmission. Temporal trends
in diagnoses were analyzed with Joinpoint regression to determine the average annual
percent change with 95% confidence intervals.
RESULTS
Of 12,334,506 deliveries in the analysis, 13,894 (1.1 per 1000) had a diagnosis of
postpartum psychosis during the delivery hospitalization, and 7128 (0.6 per 1000)
had a 60-day postpartum readmission with postpartum psychosis. Readmissions with postpartum
psychosis increased significantly during the study period (P=.046). Most readmissions with a postpartum psychosis diagnosis occurred in 0 to 10
days (43% of readmissions) or 11 to 20 days (18% of readmissions) after discharge.
Clinical factors with the highest adjusted odds for postpartum psychosis readmission
included delivery postpartum psychosis (adjusted odds ratio, 5.8; 95% confidence interval,
4.2–8.0), depression disorder (adjusted odds ratio, 3.7; 95% confidence interval,
3.3–4.2), bipolar spectrum disorder (odds ratio, 2.9; 95% confidence interval, 2.3–3.5),
and schizophrenia spectrum disorder (adjusted odds ratio, 2.9; 95% confidence interval,
2.1–4.0). In models analyzing postpartum psychosis diagnoses at delivery, risk factors
associated with the highest odds included anxiety disorder (adjusted odds ratio, 3.9;
95% confidence interval, 3.5–4.2), schizophrenia spectrum disorder (adjusted odds
ratio, 2.5; 95% confidence interval, 1.9–3.4), bipolar disorder (adjusted odds ratio,
1.8; 95% confidence interval, 1.6–2.1), stillbirth (odds ratio, 3.6; 95% confidence
interval, 3.1–4.2), and substance use disorder (odds ratio, 1.7; 95% confidence interval,
1.6–1.9). In addition, chronic conditions, such as pregestational diabetes mellitus,
obesity, and substance use, were associated with delivery and readmission postpartum
psychosis.
CONCLUSION
This study determined that postpartum psychosis is increasing during postpartum readmissions
and is associated with a wide range of obstetrical and medical comorbidities. Close
follow-up care after delivery for other medical and obstetrical diagnoses may represent
an opportunity to identify postpartum psychiatric conditions, including postpartum
psychosis.
Key words
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Article info
Publication history
Published online: February 10, 2023
Accepted:
February 7,
2023
Received in revised form:
February 6,
2023
Received:
December 15,
2022
Footnotes
M.E.D.A had a senior leadership role in the American College of Obstetricians and Gynecologists II Safe Motherhood Initiative, which received unrestricted funding from Merck for Mothers. T.W. serves as a consultant on the medical advisory board for Delfina Care, Inc. The other authors report no conflict of interest.
Given that this study involved a deidentified and publicly available dataset, the institutional review board review by both Columbia University and the University of California, San Francisco, deemed this exempt from review.
Cite this article as: Albers SM, Wen T, Monk C, et al. Postpartum psychosis during delivery hospitalizations and postpartum readmissions, 2016–2019. Am J Obstet Gynecol MFM 2023;XX:x.ex–x.ex.
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