Original Research| Volume 5, ISSUE 5, 100905, May 2023

Postpartum psychosis during delivery hospitalizations and postpartum readmissions, 2016–2019

Published:February 10, 2023DOI:


      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.


      This study aimed to determine trends in and risk factors for postpartum psychosis during delivery hospitalizations and postpartum readmissions.


      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.


      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.


      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology MFM
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • VanderKruik R
        • Barreix M
        • Chou D
        • et al.
        The global prevalence of postpartum psychosis: a systematic review.
        BMC Psychiatry. 2017; 17: 272
        • Harlow BL
        • Vitonis AF
        • Sparen P
        • Cnattingius S
        • Joffe H
        • Hultman CM
        Incidence of hospitalization for postpartum psychotic and bipolar episodes in women with and without prior prepregnancy or prenatal psychiatric hospitalizations.
        Arch Gen Psychiatry. 2007; 64: 42-48
        • Jones I
        • Craddock N
        Familiality of the puerperal trigger in bipolar disorder: results of a family study.
        Am J Psychiatry. 2001; 158: 913-917
        • Miller BJ
        • Goldsmith DR
        Towards an immunophenotype of schizophrenia: progress, potential mechanisms, and future directions.
        Neuropsychopharmacology. 2017; 42: 299-317
        • Tabacco S
        • Ludovisi M
        • D'Alfonso A
        • et al.
        Perinatal mental illness and autoimmune diseases: a qualitative sistematic review.
        Minerva Obstet Gynecol. 2022; ([Epub ahead of print])
        • Logue TC
        • Wen T
        • Ogundimu OE
        • et al.
        Delivery hospitalizations with substance use disorder diagnoses.
        Am J Obstet Gynecol. 2022; 227: 100-102
        • Logue TC
        • Wen T
        • Monk C
        • et al.
        Trends in and complications associated with mental health condition diagnoses during delivery hospitalizations.
        Am J Obstet Gynecol. 2022; 226 (e1–16): 405
        • Dinse GE
        • Parks CG
        • Weinberg CR
        • et al.
        Increasing prevalence of antinuclear antibodies in the United States.
        Arthritis Rheumatol. 2020; 72: 1026-1035
        • Agency for Healthcare Research and Quality
        Introduction to the HCUP Nationwide Readmissions Database (NRD) 2010-2015.
        2017 (Available at:) (Accessed July 1, 2019)
        • Kurtz SM
        • Lau EC
        • Ong KL
        • Adler EM
        • Kolisek FR
        • Manley MT
        Which clinical and patient factors influence the national economic burden of hospital readmissions after total joint arthroplasty?.
        Clin Orthop Relat Res. 2017; 475: 2926-2937
        • Wen T
        • Wright JD
        • Goffman D
        • et al.
        Postpartum venous thromboembolism readmissions in the United States.
        Am J Obstet Gynecol. 2018; 219 (e1–14): 401
        • Wen T
        • Yu VX
        • Wright JD
        • et al.
        Postpartum length of stay and risk for readmission among women with preeclampsia.
        J Matern Fetal Neonatal Med. 2020; 33: 1086-1094
        • Wen T
        • Overton EE
        • Sheen JJ
        • et al.
        Risk for postpartum readmissions and associated complications based on maternal age.
        J Matern Fetal Neonatal Med. 2021; 34: 1375-1381
        • Fein A
        • Wen T
        • Wright JD
        • et al.
        Postpartum hemorrhage and risk for postpartum readmission.
        J Matern Fetal Neonatal Med. 2021; 34: 187-194
        • Healthcare Cost and Utilization Project
        Overview of the nationwide readmissions database.
        Agency for Healthcare Research and Quality. 2022 (Available at:) (Accessed September 8, 2022)
        • Kuklina EV
        • Whiteman MK
        • Hillis SD
        • et al.
        An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity.
        Matern Child Health J. 2008; 12: 469-477
        • Clapp MA
        • James KE
        • Friedman AM
        Identification of delivery encounters using International Classification of Diseases, Tenth Revision, diagnosis and procedure codes.
        Obstet Gynecol. 2020; 136: 765-767
        • National Cancer Institute
        Joinpoint trend analysis software.
        2020 (Available at:) (Accessed June 30, 2022)
        • Grohskopf LA
        • Sokolow LZ
        • Broder KR
        • Walter EB
        • Fry AM
        • Jernigan DB
        Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices-United States, 2018-19 influenza season.
        MMWR Recomm Rep. 2018; 67: 1-20
        • Gur RE
        • Moore TM
        • Rosen AFG
        • et al.
        Burden of environmental adversity associated with psychopathology, maturation, and brain behavior parameters in youths.
        JAMA Psychiatry. 2019; 76: 966-975
        • Luo Y
        • Zhang L
        • He P
        • Pang L
        • Guo C
        • Zheng X
        Individual-level and area-level socioeconomic status (SES) and schizophrenia: cross-sectional analyses using the evidence from 1.9 million Chinese adults.
        BMJ Open. 2019; 9e026532
        • Burns EM
        • Rigby E
        • Mamidanna R
        • et al.
        Systematic review of discharge coding accuracy.
        J Public Health (Oxf). 2012; 34: 138-148