Associations of antepartum suicidal behaviour with adverse infant and obstetric outcomes

Relatively little is known about antepartum suicidal behaviour and pregnancy outcomes. We examined associations of antepartum suicidal behaviour, alone and in combination with psychiatric disorders, with adverse infant and obstetric outcomes.

We included 188 925 singleton livebirths from a retrospective cohort (1996-2016). Suicidal behaviour, psychiatric disorders, and outcomes were derived from electronic medical records. We performed multivariable logistic regressions with generalised estimating equations to estimate adjusted odds ratios (aOR) with 95% confidence intervals (95%CI).

The prevalence of antepartum suicidal behaviour was 152.44 per 100 000 singleton livebirths. Nearly two-thirds (64.24%) of women with suicidal behaviour also had psychiatric disorders. Compared to women without psychiatric disorders and suicidal behaviour, women with psychiatric disorders alone had 1.3-fold to 1.4-fold increased odds of delivering low birthweight or preterm infants and 1.2-fold increased odds of experiencing obstetric complications. Women with suicidal behaviour alone had increased odds of preterm labour (aOR 2.05, 95% CI 1.16, 3.62). Women with both suicidal behaviour and psychiatric disorders had > twofold increased odds of delivering low birthweight (aOR 2.52, 95% CI 1.40, 4.54), preterm birth (aOR 2.44, 95% CI 1.63, 3.66), and low birthweight/preterm birth (aOR 2.30, 95% CI 1.54, 3.44) infants; the odds of preterm labour (aOR 1.62, 95% CI 1.06, 2.47), placental abruption (aOR 2.33, 95% CI 1.20, 4.51), preterm rupture of membranes (aOR 1.63, 95% CI 1.08, 2.46), and postpartum haemorrhage (aOR 1.93, 95%CI 1.09, 3.40) were elevated.

Antepartum suicidal behaviour, when co-occurring with psychiatric disorders, is associated with increased odds of adverse infant and obstetric outcomes. Future studies are warranted to understand the causal roles of suicidal behaviour and psychiatric disorders in pregnancy.