Evidence map›Paper›PMID 41166709›Full record

ArticleObstetrics and gynecology2026

Association Between Mental Illness and Risk of Severe Maternal Morbidity in Pregnant Veterans.

Danielle M Panelli, Aryan Esmaeili, Vilija R Joyce, Caitlin S Chan, Kritee Gujral, Susan K Schmitt, Nicole F Murphy, Rachel Kimerling, McKenzie Lockett, Stephanie A Leonard and 3 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Obstetrics and gynecology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Obstetrical and Neonatal Outcomes in Pregnant Individuals With Anxiety Disorders.The journal of obstetrics and gynaecology research · 2026
    Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Danielle M PanelliDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Aryan EsmaeiliDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Vilija R JoyceDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Caitlin S ChanDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Kritee GujralDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Susan K SchmittDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Nicole F MurphyDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Rachel KimerlingDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
McKenzie LockettDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Stephanie A LeonardDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Elliott K MainDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Jonathan G ShawDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.
Ciaran S PhibbsDivision of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Computational Brain Research and Intervention (C-BRAIN) Lab, Department of Psychiatry and Behavioral Sciences, the Department of Psychiatry and Behavioral Sciences, the Division of Primary Care and Population Health, the Division of Neonatology, Department of Pediatrics, and the Department of Health Policy, Stanford University School of Medicine, Stanford, the VA Health Economics Resource Center (HERC), U.S. Department of Veterans Affairs, the National Center for PTSD, Dissemination and Training Division, and the VA HSR Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, and the University of California, Berkeley, Berkeley, California.

Funding

Stanford Women's Reproductive Health Research Career Development ProgramK12HD103084 · NICHD · STANFORD UNIVERSITY · PI LESLEE L SUBAK · 2020 to 2026
$2.2M
Leveraging psychobiologic markers of stress to reduce severe maternal morbidity in pregnant women with mental illnessK23HD113845 · NICHD · STANFORD UNIVERSITY · PI Danielle Mari Panelli · 2024 to 2026
$497k
HSRD VA I01 HX003314National Institute of Child Health and Human Development 1K23HD113845National Institute of Child Health and Human Development K12HD103084NICHD NIH HHS K12 HD103084NICHD NIH HHS K23 HD113845U.S. Department of Veterans Affairs IIR 20-314
6 · The paper itself

Abstract

objectiveMental illness is a leading cause of maternal mortality, yet population-level research is hindered by limited antenatal mental health data. The Veterans Health Administration, which offers universal outpatient mental health and substance use screening and resources, provides a unique opportunity to assess the effects of antenatal mental illness on severe maternal morbidity (SMM; a composite of life-threatening events around the time of childbirth).

methodsWe conducted a population-level retrospective cohort study of births reimbursed by the Veterans Health Administration in fiscal years 2010-2020. The exposure was antenatal mental illness, identified by International Classification of Disease, Ninth or Tenth Revision, Clinical Modification codes for depression, anxiety, posttraumatic stress disorder, or other serious mental illness, categorized as "active" (coded 1 year or less before childbirth) or "historical" only (coded only more than 1 year before childbirth). The outcome was SMM, defined with the established Health Resources & Services Administration composite. Sequential multivariable Poisson regression models with robust standard errors were conducted, adjusted for sociodemographic confounders. A mediation analysis was conducted to assess the potential contribution of substance use disorders to the relationship between mental illness and SMM.

resultsOf 47,883 eligible births, 3.6% of veterans had historical mental illness and 17.4% had active antenatal mental illness. Compared with veterans with no prior mental illness, the risk of SMM was increased in veterans with active mental illness (2.0% vs 1.2%, adjusted risk ratio [aRR] 1.38, 95% CI, 1.15-1.67). There was no significant increase in risk among those with historical mental illness (aRR 0.87, 95% CI, 0.57-1.31). Substance use disorders were not found to be a significant mediator of the association between active mental illness and SMM.

conclusionActive, but not historical, antenatal mental illness was independently associated with higher risk of SMM among pregnant veterans. These findings highlight a potential role for addressing mental health during pregnancy as part of broader efforts to reduce SMM.

Indexed as

Mental DisordersPregnancy ComplicationsVeteransAdultFemaleHumansPregnancyRetrospective StudiesRisk FactorsSubstance-Related DisordersUnited States

Identifiers

PMID41166709
PMCPMC12614346

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.