330 - Does maternal mental illness influence mode of delivery?

Poster Number: 330
Publication Number: 330.447

Sarah M. Sanchez, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States; KRITI DAMODARAN, Maria Fareri Children's Hospital at Westchester Medical Center, White Plains, NY, United States; Shetal Shah, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, United States; Rachel C. Feurstein, Maria Fareri Children's Hospital at Westchester Medical Center, Bedford, NY, United States; Clare Giblin, Maria Fareri Children's Hospital at Westchester Me, Valhalla, NY, United States; Elissa Dunlap, Maria Fareri Children's Hospital at Westchester Medical Center, New York, NY, United States; Heather Brumberg, Westchester Medical Center, White Plains, NY, United States

Background: The presence of maternal mental health conditions is a risk factor for adverse birth outcomes, including prematurity & low birthweight.  Further, mental illness is associated with higher rates of social stress and lifestyle characteristics such as home/economic instability or substance use.  However, the relationship of baseline maternal mental health and delivery mode, controlling for concurrent adverse life events and behaviors has not been well delineated.

Objective: To determine whether preexisting maternal mental illness is associated with higher rates of cesarean delivery (C/S) accounting for social determinants of health.

Design/Methods: This is a cross sectional study (2016-2021) of maternal (≥18 yrs) survey merged with electronic birth certificate data of singleton live births at 6 birthing hospitals. Mothers were classified into those with mental illness (self-reported anxiety, depression, bipolar, schizophrenia or other) and without. Maternal characteristics included demographics, adverse life events [ALE ≥3 of 14 stressors such as homelessness, financial instability or self/partner incarceration], lifestyle behaviors & pregnancy history. Logistic regression assessed associations of maternal mental illness and C/S overall, adjusting for race, education, marital status, insurance, exercise, prenatal care, ALE, high risk pregnancy (defined as comorbidities or extremes of age), substance use and previous C/S.  Subgroups analysis included term ( >37 wks) & preterm populations.  Receiver Operator curves with concordance index (C-statistic) were generated to assess predictive accuracy.

Results: 1102 mothers were analyzed, of which 157 reported mental illness.  Mothers with mental illness had higher rates of overall and term-only C/S delivery, substance use, ALE, Medicaid insurance & lower rates of marriage and foreign-born status (Table 1).  In adjusted analysis, mothers with mental illness had higher odds of C/S overall (OR 1.67, CI 1.07-2.58; C-statistic 0.76), among term-only mothers (OR 1.69, CI 1.05-2.70; C-statistic 0.77) but not preterm.

Conclusion(s): When accounting for social determinants of health, maternal preexisting mental illness is a risk factor for C/S overall and in the term-only subgroup.  We speculate other clinical factors may influence the risk of preterm C/S over mental illness. Lower risk mothers with preexisting mental illness may require additional support & counseling to prevent unnecessary C/S at term.