{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T21:06:38Z","timestamp":1789247198730,"version":"build-2803163510"},"reference-count":53,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["K12-TR004788"],"award-info":[{"award-number":["K12-TR004788"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Mental health disorders (MHDs) and substance-use disorders (SUDs) are implicated in preventable pregnancy-associated mortality (PAM) in the USA. However, the independent and joint associations of perinatal MHDs\/SUDs on PAM are not well understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the Nationwide Readmissions Database from 2010 to 2020. We examined the risks of PAM within the calendar year of delivery among women with and without MHDs\/SUDs at delivery and further contrasted MHDs (depression, anxiety, bipolar, or psychotic disorders) with and without SUDs, and SUDs alone. We estimated the confounder-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). We conducted a probabilistic bias analysis to address exposure misclassification and unmeasured confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 19\u200a703\u200a242 women with a delivery hospitalization, 9.4% (n\u2009=\u20091\u200a865\u200a087) had an MHD\/SUD diagnosed at delivery. Of 1989 pregnancy-associated in-hospital deaths, 21.7% (n\u2009=\u2009432) occurred among women with an MHD\/SUD diagnosis. Compared with those without MHDs\/SUDs, the HR for mortality associated with MHDs\/SUDs was 2.30 (95% CI 2.04, 2.59). Women with MHDs alone had an HR of 1.49 (95% CI 1.24, 1.79) for mortality, whereas those with both MHDs and SUDs had an even higher HR (2.90, 95% CI 2.28, 3.68). The mortality HR associated with SUDs alone was 3.55 (95% CI 3.00, 4.21). These associations increased slightly following correction for exposure misclassification and unmeasured confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This population-based study highlights the disproportionately high rates of PAM associated with MHDs\/SUDs. Increased efforts to address MHDs\/SUDs in pregnancy are essential to reduce PAM related to MHDs\/SUDs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyag112","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T18:13:46Z","timestamp":1784830426000},"source":"Crossref","is-referenced-by-count":0,"title":["Mental health disorders, substance use, and pregnancy-associated mortality"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0592-3000","authenticated-orcid":false,"given":"Rachel","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School , New Brunswick, NJ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8989-7878","authenticated-orcid":false,"given":"Elizabeth A","family":"Suarez","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School , New Brunswick, NJ,","place":["United States"]},{"name":"Department of Biostatistics and Epidemiology, Rutgers School of Public Health , Piscataway, NJ,","place":["United States"]},{"name":"Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University , New Brunswick, NJ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1131-8148","authenticated-orcid":false,"given":"Emily B","family":"Rosenfeld","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School , New Brunswick, NJ,","place":["United States"]},{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School , New Brunswick, NJ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2317-5607","authenticated-orcid":false,"given":"K S","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, University of British Columbia and the Children\u2019s and Women\u2019s Hospital and Health Centre of British Columbia , Vancouver,","place":["Canada"]},{"name":"School of Population and Public Health, University of British Columbia , Vancouver,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5624-021X","authenticated-orcid":false,"given":"Katherine M","family":"Keyes","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Joseph L. 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