Association between perinatal mood and anxiety disorder diagnosis and primary cesarean delivery among national Medicaid enrollees, 2017-2022

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Background: Cesarean deliveries can have an association with adverse maternal health outcomes, yet the relationship between perinatal mood and anxiety disorders (PMAD) and cesarean rates among publicly insured populations remains understudied and potentially underestimated. Materials and methods: Using the most current national Medicaid claims data from 2017 to 2022, this study examined the association between PMAD during pregnancy and primary cesarean delivery among reproductive-aged Medicaid beneficiaries with live births. Results: The study cohort included 3,365,248 Medicaid deliveries, of which 9.13% had a PMAD diagnosis during pregnancy. Adjusted logistic regression analyses revealed that women with PMAD had 13% greater odds of undergoing a primary cesarean delivery (Adjusted OR: 1.13, 95% CI: 1.12-1.14) than women without PMAD, after accounting for maternal age, race/ethnicity, metropolitan area residence status, and comorbid medical conditions. Conclusion: Among Medicaid enrollees, those with PMAD diagnoses had greater primary cesarean delivery rates than those without PMAD diagnoses. These findings highlight the complex interplay between maternal mental health and delivery outcomes. Study findings may support the development of effective healthcare strategies to address mental health and birth outcomes across diverse perinatal populations.

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