Research: Babies of mothers with mental illness more likely to need hospital, emergency care

Bipolar disorder and other mental illnesses in pregnant women increase the likelihood that their newborns will be hospitalized or need emergency care, finds a study published in the October issue of Hospital Pediatrics.

The study, led by David A. Paul, M.D., chair of Pediatrics at Christiana Care, is the first large-scale analysis to evaluate how mental illnesses among pregnant women are tied to the serious medical needs of their newborns. According to the U.S. National Institute of Mental Health, 21.8 percent of adult women in the United States experience mental illness.

The study evaluated more than 4,000 infants who were delivered at Christiana Care Health System’s Christiana Hospital, the only high-risk delivering hospital in Delaware that offers the highest level of neonatal intensive care. The study found that 11 percent of babies were hospitalized and 41 percent were treated in the emergency department within their first six months of life.

The findings also uncover unique insights that can be used to deliver high-value care to clients of the federal-state insurance program Medicaid, a critical healthcare safety net for more than 161,000 Delawareans who live below the poverty line and, in general, one of the largest consumers of state budgets.

“The study shines a bright light on the importance of mental and behavioral health on the overall health of women and their babies,” said Dr. Paul, chair of Pediatrics and lead of the Women & Children’s service line at Christiana Care. “Specifically, the findings underscore the potential value of increasing access to mental health through the integration of behavioral health specialists into primary care, which opens mental health doors to thousands of pregnant women so they achieve optimal health.“

“We know that feeling unprepared for parenthood is associated with increased infant hospitalization and use of the Emergency Department, so it’s important for us to look for ways to support new parents, especially those struggling with mental health issues,” said Rita Landgraf, secretary of the Delaware Department of Health and Social Services, which oversees Medicaid. “This study speaks to the importance of the integration of behavioral health care with primary care, and in this case, specialty care, and of connecting individuals with the treatment services they need.”

Historically, research has found that less than 10 percent of infants are either hospitalized or need emergency care during their first year of life.

By comparison, the study found that:

• 40 percent of newborns whose mothers were diagnosed with a mental illness other than bipolar disorder or depression needed to be hospitalized.
• 16 percent of newborns whose mothers were diagnosed with depression needed to be hospitalized.
• 11 percent of newborns whose mothers were diagnosed with bipolar disorder needed to be hospitalized.

The study also found that:

• 34 percent of newborns whose mothers were diagnosed with a mental illness other than bipolar disorder or depression needed emergency care.
• 16 percent of newborns whose mothers were diagnosed with depression needed emergency care.

As the study authors expected, the main predictor of hospitalization and emergency care was whether the newborns underwent care in the hospital’s neonatal intensive care unit. While that factor is difficult to change, the mental illness findings illustrate the value of integrating behavioral health services into primary care and OB-GYN care for pregnant women.

The study was completed by Christiana Care, Sidney Kimmel Medical College of Thomas Jefferson University, Delaware’s Department of Health & Social Services and its Division of Medicaid and Medical Assistance, the University of Wisconsin School of Medicine and Public Health, and HealthCore, Inc., whose partnership with AstraZeneca’s Real World Evidence Collaboration helped fund the study.

Other authors in the study include Matthew Hoffman, M.D., MPH, FACOG, Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology at Christiana Care; Deborah B. Ehrenthal, M.D., MPH, FACP, Lifecourse Initiative for Healthy Families Endowed Chair at the University of Wisconsin School of Medicine and Public Health; Cynthia Denemark, RPh, director of Pharmacy Services for the Delaware Division of Medicaid and Medical Assistance;  Anthony Brazen III, D.O., medical director of Delaware’s Division of Medicaid and Medical Assistance; and Abiy Agiro, Michael Pollack, and Christiana Boehmer of HealthCore.