OBJECTIVES: Congenital heart defects (CHD) affect approximately 40,000 births per year in the United States. Various combinations of genetic and secondary contributors have been proposed, and researchers continue to explore additional predictors of CHD causation. This study aimed to determine the relationship between maternal mental health disorder (MMHD) history and the incidence of abnormalities in fetal heart rate or rhythm as well as the incidence of stillbirth.

METHODS: We queried a de-identified electronic health record database (Cerner Real World Data) for patients aged 18 to 44 who had a delivery-related visit between February 1, 2019 to February 1, 2020. Using ICD-10 codes and medication history, we identified patients previously diagnosed with anxiety, depression, post-traumatic stress disorder, schizophrenia, and/or postpartum depression at any time. Outcomes of interest included stillbirth, presence of abnormal fetal heart rate or rhythm, and the need for maternal care due to fetal heart/rhythm abnormalities. We calculated odds ratios with 95% confidence intervals to assess risk between MMHD and each outcome of interest.

RESULTS: Out of 421,767 births, 95,435 were to mothers with a history of MMHD or to mothers with a psychopharmacologic medication history. Patients with a history of MMHD were more likely to experience a stillbirth, deliver a newborn affected by abnormal fetal heart rate or rhythm at birth, and receive maternal care for abnormalities in fetal heart rate or rhythm, by factors of 1.71 (95% CI: 1.58-1.85), 1.81 (95% CI: 1.56-2.09), and 1.09 (95% CI: 1.01-1.1), respectively.

CONCLUSIONS: Our findings suggest that MMHDs may increase the risk of stillbirth and fetal heart rate/rhythm abnormalities. Improving MMHD screening and treatment strategies may reduce the scale of adverse intrauterine and birth outcomes.