Infant emergency department visits, readmission, and mortality by maternal anxiety disorder during pregnancy occurring with and without other mental health conditions: a retrospective cohort study

While a link between maternal anxiety diagnoses and adverse maternal and infant outcomes has been reported, there is a paucity of data regarding infant outcomes through the first year of life in those born to individuals with anxiety only and anxiety comorbid with other mental health conditions. The sample included 5,836,541 singleton liveborn infants in California from 2007–2020. Anxiety with and without depression or a non-depression mental health condition during pregnancy were identified from ICD codes from hospital discharge records. Adverse infant outcomes evaluated included emergency department (ED) visit, readmission, or death in the first year of life. Log-linear regression was used to calculate the crude (cRR) and adjusted (aRR) relative risk and 95% confidence interval (CI) of each outcome by mental health condition grouping. To fully consider the potential influence of co-variants, we examined four different adjusted risk calculations. Patterns of comorbidity and infant outcomes were also examined within payer for birth (as an indicator of income) and racial/ethnic groupings. Infants of birthing people diagnosed with anxiety alone or anxiety and depression had reduced ED visits (cRRs 0.93 and 0.85, respectively) and readmissions (cRRs 0.85 and 0.83) but an increased risk of death (cRRs 1.40 and 1.75) compared to those without any mental health condition. Infants of people with diagnoses of anxiety and other non-depression conditions during pregnancy faced higher risks across all metrics (ED visits and readmissions cRRs 1.14–1.20, death cRRs 2.07–3.81). Observed were often tempered in fully adjusted models. Maternal anxiety diagnosis during pregnancy was associated with an elevated risk of infant death and was exacerbated by the presence of another mental health condition. These relationships were not explained by the presence of other related risks. These findings underscore the need for interventions for birthing people with anxiety, and particularly for those with comorbid mental health conditions.