Inequities and Missed Opportunities: A National Analysis of Emergency Department Visits for Pregnant Individuals with Mental Health and Substance Use Disorder

<b><i>Objective:</i></b> This study aims to identify whether there are inequities in care for pregnant individuals with mental health or substance use disorders (MH/SUDs) seeking treatment in emergency departments (EDs) for pregnancy-related concerns. Considering their risk for poor maternal and infant outcomes, we sought to examine their experiences in EDs to target future interventions and institute referrals to integrated care systems. <b><i>Methods:</i></b> This retrospective, exploratory analysis identified ED visits for pregnancy-related concerns using the National Hospital Ambulatory Medical Care Survey database from 2016 to 2020 (<i>n</i> = 1,233) to compare experiences of care by pregnant people with (<i>n</i> = 149) and without MH/SUD (<i>n</i> = 1,084). <b><i>Results:</i></b> 11.9% (95% confidence interval [CI]: 9.8 - 15.1%) of ED visits for pregnancy-related concerns were cross-coded for MH/SUD. Compared to visits by pregnant individuals without MH/SUD, visits by pregnant people with MH/SUD were 70% less likely to be asked to return to the ED for follow-up treatment (<i>p</i> = 0.027), had 3.8 times greater odds of leaving the ED prior to completing care (<i>p</i> = 0.005), and received 40% more medication upon discharge (<i>p</i> = 0.049) after controlling for demographic variables. Of those visits by pregnant people with MH/SUD, only 6.8% were given a toxicology screen and only 1.2% were seen by an MH provider. <b><i>Conclusion:</i></b> This nationally representative analysis of ED visits for pregnancy-related concerns identified multiple opportunities to address care inequities that affect health outcomes. Special training and processes are needed within EDs to engage pregnant people with MH/SUD to provide effective, evidence-based care interventions and referrals.