Maternal and child delivery charges, postpartum charges, and utilization of care among women with bipolar disorder: a cohort study

  • M. Camille HoffmanEmail author
  • Deborah J. Rinehart
  • Laura K. Jochens
  • Carolyn Valdez
  • Joshua Durfee
  • Sara E. Mazzoni
Original Article


Bipolar disorder (BD) during pregnancy is known to be a morbid condition associated with poor outcomes for both the mother and her infant. We aimed to determine if women with BD and their children have higher charges and health service utilization than mother-infant dyads with and without other mental health (MH) diagnoses. The International Classification of Diseases, Ninth Revision (ICD9) codes were used to identify mutually exclusive groups of women who gave birth between January 1, 2011, and December 31, 2012, coding first for BD, then diagnoses that comprised an “other MH diagnoses group” that included post-traumatic stress disorder, anxiety, and depression. Health service utilization and related charges were obtained for the dyad for delivery and for 2 years post-delivery at a single tertiary care center. Analyses included 4440 dyads. A BD diagnosis occurred in 1.8% of medical record codes, other MH diagnoses in 10%, and no known MH diagnosis in 88%. Compared with women with both other MH and no known MH diagnoses, women with BD had higher delivery charges (p < 0.001), higher cumulative charges in the 2 years postpartum (p < 0.001), higher preterm birth and low birthweight rates (15.5% v. 6.9% and 20.8% v. 6.4%, p < 0.001, BD v. no known MH, respectively), and greater utilization of inpatient and emergency psychiatric care services (p < 0.001). Compared with women with and without other mental health diagnoses, women with BD have the highest care utilization and charges. They also have higher preterm birth and low birthweight infant rates, two clinically relevant predictors of long-term health for the child. Given the low prevalence of BD and severity of the disease versus the magnitude of systems costs, women with BD, and their children, deserve the heightened attention afforded to other high-risk perinatal conditions.


Perinatal bipolar disorder Perinatal mental health Health care charges 


Funding information

This work was supported by the National Institutes of Health’s Eunice Kennedy Shriver National Institute of Child Health and Human Development’s Women’s Reproductive Health Research (WRHR) program grant number K12HD001271-11 and the Ben and Lucy Ana Walton Family Foundation (Zoma foundation), Denver, Colorado, [MCH].

Compliance with ethical standards

This study was approved by the Colorado Multiple Institution Review Board with exempt status.

Conflict of interest

The authors declare that they have no conflict of interest.


The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics & Gynecology, Division of Maternal Fetal MedicineUniversity of Colorado School of Medicine/Denver Health & Hospital AuthorityDenverUSA
  2. 2.Department of PsychiatryUniversity of Colorado School of MedicineAuroraUSA
  3. 3.Center for Health Systems ResearchDenver Health & Hospital AuthorityDenverUSA
  4. 4.Department of MedicineUniversity of Colorado School of MedicineAuroraUSA
  5. 5.Department of Obstetrics & GynecologyUniversity of Alabama at BirminghamBirminghamUSA

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