Association between maternal serious mental illness and adverse birth outcomes



To evaluate the contribution of serious mental illness (SMI) and specific risk factors (comorbidities and substance use) to the risk of adverse birth outcomes.

Study design

This cross-sectional study uses maternal delivery records in the Healthcare Cost and Utilization Project Nationwide/National Inpatient Sample (HCUP-NIS) to estimate risk factor prevalence and relative risk of adverse birth outcomes (e.g., preeclampsia, preterm birth, and fetal distress) in women with SMI.


The relative risk of adverse gestational (1.15, 95% CI: 1.13–1.17), obstetric (1.07, 1.06–1.08), and fetal (1.24, 1.21–1.26) outcomes is increased for women with SMI. After adjusting for risk factors, the risk is significantly reduced but remains elevated for all three adverse outcome categories (gestational: 1.08, 1.06–1.09; obstetric: 1.03, 1.02–1.05; fetal: 1.12, 1.09–1.14).


Maternal serious mental illness is independently associated with increased risk for adverse birth outcomes. However, approximately half of the excess risk is attributable to comorbidities and substance use.

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Funding sources

Our study was partially supported by an unrestricted gift to the Leonard D. Schaeffer Center for Health Policy and Economics from Alkermes (HH-J and SAS). AL is supported by grant KL2TR001854 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institute of Health. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources. 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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Correspondence to H. Heun-Johnson.

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SAS reports receiving consulting income from Precision Health Economics, a life science consulting firm, for work unrelated to this study. The other authors declare that they have no conflict of interest.

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Heun-Johnson, H., Seabury, S.A., Menchine, M. et al. Association between maternal serious mental illness and adverse birth outcomes. J Perinatol 39, 737–745 (2019).

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