Behavioral Health Conditions, Maternal Factors and Severe Maternal Morbidity in Michigan: A Statewide Analysis of Birth Hospitalizations.

Authors

Melissa Stone, Faith Smith, Sarah Nechuta

Published in

Birth (Berkeley, Calif.). Oct 19, 2026. Epub Oct 19, 2026.

Abstract

Maternal mortality continues to rise in the United States and continued monitoring of the burden and risk factors for severe maternal morbidity (SMM) is crucial. Studies have shown that maternal substance use disorders (SUDs) and mental health disorders (i.e., behavioral health disorders (BHDs)) are important risk factors for maternal mortality, but less is known for SMM. We examined maternal characteristics and BHDs in association with SMM in Michigan (MI).
We conducted a cross-sectional pooled analysis using data from the Healthcare Cost and Utilization Project State Inpatient Database (2019-2023) for birth hospitalizations for females aged ≥ 15 years in MI (n = 495,074). Using the CDC's SMM definition, SMM prevalence was determined using ICD-10-CM diagnosis and procedure codes. We examined maternal characteristics and individual BHDs in association with SMM using multivariable logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
We identified 4563 SMM events. The rate per 10,000 births increased from 78.4 (2019) to 100.1 (2023). Maternal characteristics associated with SMM included lowest zip code-level income (aOR:1.16, 95% CI: 1.12-1.40) and Black race/ethnicity (aOR:1.75, 95% CI: 1.57-1.86). Results for maternal characteristics varied by SMM type. Several BHDs, including SUDs, were associated with increased SMM. For example, the aORs (95% CI) for depression and anxiety-related disorders with SMM were 1.47(1.34-1.62) and 1.60(1.47-1.75), respectively.
We found an increase in SMM in MI and identified key risk factors, including social and mental health-related factors, which inform identification of those at risk for SMM to support targeting of resources and prevention efforts.

PMID:
42897768
Bibliographic data and abstract were imported from PubMed on 20 Oct 2026.

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