Relationship between Depression and Anxiety during Pregnancy, Delivery-Related Outcomes, and Healthcare Utilization in Michigan Medicaid, 2012–2021
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Published:2023-11-07
Issue:22
Volume:11
Page:2921
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ISSN:2227-9032
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Container-title:Healthcare
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language:en
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Short-container-title:Healthcare
Author:
Zivin Kara123ORCID, Zhang Xiaosong3, Tilea Anca3ORCID, Clark Sarah J.4, Hall Stephanie V.25ORCID
Affiliation:
1. Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA 2. Department of Psychiatry, Michigan Medicine, Ann Arbor, MI 48109, USA 3. Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI 48109, USA 4. Ambulatory Care Program, Department of Pediatrics, Michigan Medicine, Ann Arbor, MI 48109, USA 5. Department of Learning Health Sciences, Michigan Medicine, Ann Arbor, MI 48109, USA
Abstract
To evaluate associations between depression and/or anxiety disorders during pregnancy (DAP), delivery-related outcomes, and healthcare utilization among individuals with Michigan Medicaid-funded deliveries. We conducted a retrospective delivery-level analysis comparing delivery-related outcomes and healthcare utilization among individuals with and without DAP between January 2012 and September 2021. We used generalized estimating equation models assessing cesarean and preterm delivery; 30-day readmission after delivery; severe maternal morbidity within 42 days of delivery; and ambulatory, inpatient, emergency department or observation (ED), psychotherapy, or substance use disorders (SUD) visits during pregnancy. We adjusted models for age, race/ethnicity, urbanicity, federal poverty level, and obstetric comorbidities. Among 170,002 Michigan Medicaid enrollees with 218,890 deliveries, 29,665 (13.6%) had diagnoses of DAP. Compared to those without DAP, individuals with DAP were more often White, rural dwelling, had lower income, and had more comorbidities. In adjusted models, deliveries with DAP had higher odds of cesarean and preterm delivery OR = 1.02, 95% CI: [1.00, 1.05] and OR = 1.15, 95% CI: [1.11, 1.19] respectively), readmission within 30 days postpartum (OR = 1.14, 95% CI: [1.07, 1.22]), SMM within 42 days (OR = 1.27, 95% CI: [1.18, 1.38]), and utilization compared to those without DAP diagnoses (ambulatory: OR = 7.75, 95% CI: [6.75, 8.88], inpatient: OR = 1.13, 95% CI: [1.11, 1.15], ED: OR = 1.86, 95% CI: [1.80, 1.92], psychotherapy: OR = 172.8, 95% CI: [160.10, 186.58], and SUD: OR = 5.6, 95% CI: [5.37, 5.85]). Among delivering individuals in Michigan Medicaid, DAP had significant associations with adverse delivery-related outcomes and greater healthcare use. Early detection and intervention to address mental illness during pregnancy may help mitigate burdens of these complex yet treatable disorders.
Funder
Michigan Department of Health and Human Services
Subject
Health Information Management,Health Informatics,Health Policy,Leadership and Management
Reference34 articles.
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