Obstetric Complications in Women with Diagnosed Mental Illness

The Relative Success of California's County Mental Health System

Although approximately 22 percent of Americans have a diagnosed mental disorder in a given year, and women are most likely to be afflicted during their childbearing years, little research has been done on mental health and obstetric outcomes in the U.S. population.

This cross-sectional study linked records for all women ages 12 to 50 who gave birth in California hospitals in 2000 and 2001, with county mental health records and infant birth certificates. The sample consisted of approximately 915,500 deliveries, of which more than 886,000 were to women with no record of mental illness; almost 19,000 were to women who had a history of mental illness but did not receive treatment through California’s public mental health system (non-CMHS); and more than 10,000 were to women who received public mental health services at some point during the study (CMHS).

Key Findings:

  • Women with a record of mental illness are at significantly higher risk than the general population for any complication during labor and delivery and show an increased risk for almost every complication.
  • Compared to mentally ill women who are treated privately or not at all, CMHS women are more “demographically vulnerable” (younger, less educated, black or non-Hispanic White, reliant on Medicaid) and have higher rates of serious mental illness.
  • After controlling for socio-demographics, clinical factors and the type of hospital in which they delivered their babies, CMHS women have a 32 percent increased risk of labor or delivery complications compared to the general population. Non-CMHS women have an even greater increased risk—72 percent—over the general population.
  • Non-CMHS women are at increased risk for almost every obstetric complication compared to CMHS women.
  • Mentally ill women are at higher risk than the general population for most of the specific complications which suggest inadequate prenatal or obstetric care. CMHS women are at lower risk than non-CMHS women for almost every one of these complications.

This study found a strong and consistent relationship between mental illness and obstetric complications. The study also revealed mentally ill women treated within California’s public mental health system have significantly better outcomes than mentally ill women who were treated privately or not at all. The impact of mental illness on the health of women and their infants is profound. More work needs to be done to understand why women treated by California’s public mental health system have better obstetrical outcomes so care can be improved to all mentally ill pregnant women.