Preconception Mental Health Status and Pregnancy-Related Healthcare Use and Expenditures in the US

Background: We examined if and to what extent women's preconception mental health status impacted subsequent pregnancy-related healthcare use and expenditures.

Methods: We examined 4,084 women using data from the 1996-2006 Medical Expenditure Panel Survey (MEPS), a national, population-based panel survey. Preconception mental health was defined as women's poor mental health before conception. Data included emergency room, inpatient, and office-based and outpatient healthcare use and expenditures from the MEPS Household Event Files. Mean healthcare use and expenditures were estimated using a two-part model and confidence intervals were estimated using bootstrapping techniques to replicate analyses 1000 times.

Results: 8.4% of pregnant women reported poor mental health prior to pregnancy. Women with poor preconception mental health were significantly more likely to have pregnancy-related ER visits and higher expenditures ($22.08 more in total expenditures and $204.20 more in total charges), controlling for confounders. In contrast, women who reported poor preconception mental health had significantly fewer office based and outpatient pregnancy-related visits (7.86 versus 9.15 for women in good preconception mental health) and expenditures. These women also had fewer pregnancy-related inpatient stays and lower expenditures associated with inpatient stays.

Conclusion: Preconception mental health status predicts the setting in which women receive and the expenditures associated with pregnancy-related healthcare services. Accordingly, healthcare providers in both emergency and non-emergency settings should strive to identify and treat women's preconception mental health problems in an effort to optimize pregnancy-related healthcare use and improve the survival, long-term health, quality of life, and well-being of children and their mothers.