Risk of postpartum readmission for depression in patients with ischemic placental disease

There are limited data on postpartum hospitalizations for depression in the United States. Specifically, the extent to which ischemic placental disease (IPD) during pregnancy predisposes patients to develop postpartum depression remains poorly understood. We determined the risk of postpartum readmission for new onset depression in the first year after delivery following a pregnancy complicated by IPD. We performed a retrospective cohort study of all singleton births in the United States from 2010-2018 using the Healthcare Cost and Utilization Project Nationwide Readmissions Database. Using ICD coding, we identified all readmissions for depression during the first year after delivery in patients who had IPD, defined as having one or more diagnosis of preeclampsia, placental abruption, or small for gestational age (SGA) birth. Patients with a psychiatric diagnosis prior to delivery were excluded. We calculated rates of depression readmission (per 100,000 person-months of follow-up) and expressed associations between IPD and depression rehospitalization based on confounder-adjusted hazard ratio (HR) with 95% confidence interval (CI). Of a total of 33.3 million delivery hospitalizations, 88,404 patients were re-admitted with postpartum depression, of which 14,504 (16%) had IPD. The median follow-up among those with IPD and without IPD was 5.8 months for both groups. Patients with pregnancies complicated by any IPD were at over two-fold increased hazard of hospitalization for depression (adjusted HR 2.62, 95% CI 2.54, 2.71), with the highest risk for those with preeclampsia with severe features (adjusted HR 2.93, 95% CI 2.79, 3.06) (Table). Patients with pregnancies complicated by IPD including preeclampsia, placental abruption, or SGA births are at increased risk of hospitalization for depression in the year following delivery. These data demonstrate the need for increased surveillance, improved detection, and faster treatment of psychiatric disease in this population.