Watch for Later Risk of Postpartum Psychiatric Readmission

LAS VEGAS — Postpartum psychiatric readmissions were least likely to occur after women were immediately discharged from the hospital, a researcher said here.

When examining 60-day postpartum psychiatric readmissions, those readmissions were least likely to occur in the first 10 days following discharge from the hospital, reported Timothy Wen, MD, of Columbia University Irving Medical Center in New York City.

Not surprisingly, women with psychiatric diagnoses at the time of delivery were also nearly 10 times more likely to be readmitted for a psychiatric condition in the postpartum period (adjusted RR 9.86, 95% CI 9.16-10.61).

At a presentation at the annual meeting of the Society for Maternal-Fetal Medicine, Wen said that psychiatric disease in the postpartum period is a major concern, but little is known regarding the burden and timing of psychiatric readmissions in the U.S.

For the study, he and his colleagues examined data from the 2010-2014 Nationwide Readmissions Database, with three objectives:

• Characterize the risk of postpartum psychiatric readmissions in a national sample

• Determine the temporality of psychiatric readmissions

• Identify risk factors associated with readmission

Psychiatric readmission was defined as a primary readmission diagnosis of psychosis, substance abuse, episodic mood disorders, depression, adjustment disorders, or psychosis “not otherwise specified.”

Overall, there were 17.2 million deliveries from 2010-2014, and 11,535 (0.06%) 60-day readmissions for psychiatric indications, with a 5.7% rate of overall psychiatric comorbidity.

Patients who were readmitted tended to be younger (with about 30% ages 20-24) than patients with no readmission (with about 28% ages 25-29). About two-thirds of readmitted patients had Medicaid compared with about half of patients with no readmission who had private insurance. Not surprisingly, 40.8% of readmitted patients had psychiatric comorbidities identified versus 5.3% of patients with no readmission.

Compared with patients with no readmission, patients who were readmitted had a higher rate of cesarean delivery (36.1% vs 33%, respectively), as well as higher rates of pre-gestational diabetes, hypertensive diseases of pregnancy, chronic hypertension, and multiple gestations.

“Our research suggests that the standard postpartum visit may not be appropriate for certain women,” said study co-author Alexander Friedman, MD, also of Columbia Irving Medical Center, in a statement. “Obstetric care providers should be aware of the risk factors for psychiatric readmissions and work to optimize postpartum care for at-risk women.”

When examining readmission temporality, the researchers found that 20.7% of readmissions were likely to occur within 11-20 days of hospital discharge, followed by 31-40 days (18.0%) and 21-30 days (17.9%). However, only 10% of readmissions were likely to occur within 0-10 days of hospital discharge.

Sensitivity analyses also found an association with younger age (ages 15-19), Medicare/Medicaid insurance, and lower income quartiles and readmission risk, the authors said. Patients with multiple gestations also had a risk of psychiatric readmission that was more than two times higher.

Wen concluded that the results highlight “a very targetable group for intervention and closer antepartum follow-up.”