Advertisement

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
  • 40 Downloads

Abstract

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.

Keywords

Perinatal bipolar disorder Perinatal mental health Health care charges 

Notes

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.

Disclaimer

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.

References

  1. Battle CL, Weinstock LM, Howard M (2014) Clinical correlates of perinatal bipolar disorder in an interdisciplinary obstetrical hospital setting. J Affect Disord 158:97–100CrossRefGoogle Scholar
  2. Bergink V, Bouvy PF, Vervoort JS, Koorengevel KM, Steegers EA, Kushner SA (2012) Prevention of postpartum psychosis and mania in women at high risk. Am J Psychiatry 169(6):609–615CrossRefGoogle Scholar
  3. Blackmore ER, Rubinow DR, O'Connor TG, Liu X, Tang W, Craddock N, Jones I (2013) Reproductive outcomes and risk of subsequent illness in women diagnosed with postpartum psychosis. Bipolar Disord 15(4):394–404CrossRefGoogle Scholar
  4. Boden R, Lundgren M, Brandt L, Reutfors J, Andersen M, Kieler H (2012) Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ 345:e7085CrossRefGoogle Scholar
  5. Chaudron LH, Pies RW (2003) The relationship between postpartum psychosis and bipolar disorder: a review. J Clin Psychiatry 64(11):1284–1292CrossRefGoogle Scholar
  6. Committee on Obstetric, P (2015) The American College of Obstetricians and Gynecologists Committee Opinion no. 630. Screening for perinatal depression. Obstet Gynecol 125(5):1268–1271CrossRefGoogle Scholar
  7. Di Florio A, Forty L, Gordon-Smith K, Heron J, Jones L, Craddock N, Jones I (2013) Perinatal episodes across the mood disorder spectrum. JAMA Psychiatry 70(2):168–175CrossRefGoogle Scholar
  8. Hauck Y, Rock D, Jackiewicz T, Jablensky A (2008) Healthy babies for mothers with serious mental illness: a case management framework for mental health clinicians. Int J Ment Health Nurs 17(6):383–391CrossRefGoogle Scholar
  9. Heron J, McGuinness M, Blackmore ER, Craddock N, Jones I (2008) Early postpartum symptoms in puerperal psychosis. BJOG 115(3):348–353CrossRefGoogle Scholar
  10. Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J (2014) Non-psychotic mental disorders in the perinatal period. Lancet 384(9956):1775–1788CrossRefGoogle Scholar
  11. Jones I, Chandra PS, Dazzan P, Howard LM (2014) Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 384(9956):1789–1799CrossRefGoogle Scholar
  12. Kendig S, Keats JP, Hoffman MC, Kay LB, Miller ES, Moore Simas TA, Frieder A, Hackley B, Indman P, Raines C, Semenuk K, Wisner KL, Lemieux LA (2017) Consensus bundle on maternal mental health: perinatal depression and anxiety. Obstet Gynecol 129(3):422–430CrossRefGoogle Scholar
  13. Lindahl V, Pearson JL, Colpe L (2005) Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Mental Health 8(2):77–87CrossRefGoogle Scholar
  14. Luca DL, Garlow N, Staatz C, Margiotta C, Zivin K (2019). Societal costs of untreated perinatal mood and anxiety disorders in the United States. Mathematica Policy Research. Mathematica-MPR.com
  15. Mei-Dan E, Ray JG, Vigod SN (2015) Perinatal outcomes among women with bipolar disorder: a population-based cohort study. Am J Obstet Gynecol 212(3):367 e361–367 e368CrossRefGoogle Scholar
  16. Palladino CL, Singh V, Campbell J, Flynn H, Gold KJ (2011) Homicide and suicide during the perinatal period: findings from the National Violent Death Reporting System. Obstet Gynecol 118(5):1056–1063CrossRefGoogle Scholar
  17. Sit D, Rothschild AJ, Wisner KL (2006) A review of postpartum psychosis. J Women's Health (Larchmt) 15(4):352–368CrossRefGoogle Scholar
  18. Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 384(9956):1800–1819CrossRefGoogle Scholar
  19. Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65(7):805–815CrossRefGoogle Scholar
  20. Viguera AC, Tondo L, Koukopoulos AE, Reginaldi D, Lepri B, Baldessarini RJ (2011) Episodes of mood disorders in 2,252 pregnancies and postpartum periods. Am J Psychiatry 168(11):1179–1185CrossRefGoogle Scholar

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

Personalised recommendations