title: Effect of Borderline Personality Disorder on Obstetrical and Neonatal Outcomes.
abstract: BACKGROUND
  Borderline personality disorder (BPD) is a serious mental disorder commonly associated with functional impairments and adverse health outcomes. Very little is known about BPD in pregnant women; hence, our study objective was to evaluate the effect of BPD on obstetrical and neonatal outcomes.
  
  
  METHODS
  We carried out a retrospective cohort study using the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample from 2003 to 2012. We identified births using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic and procedure codes and classified women by BPD status. Multivariate logistic regression was used to evaluate the effect of BPD on obstetrical and neonatal outcomes, adjusted for subject baseline characteristics.
  
  
  RESULTS
  During the study period, there were 989 births to women with BPD with an overall incidence of 11.65 in 100,000 births. Women with BPD were more likely younger, of lower socioeconomic status, smoked or used drugs, and had an underlying mental disorder. Unadjusted models revealed that BPD was associated with an increased risk of almost all adverse maternal and fetal outcomes we examined, the exception being post partum hemorrhage and instrumental delivery, which both had a null association with BPD, and induction of labor, which was negatively associated with BPD. Upon full adjustment, BPD was found to be associated with the following obstetrical and neonatal outcomes: gestational diabetes (odds ratio [OR], 1.45; 95% CI, 1.13-1.85), premature rupture of the membranes (OR, 1.40; 95% CI, 1.07-1.83), chorioamnionitis (OR, 1.65; 95% CI, 1.14-2.39), venous thromboembolism (OR, 2.11; 95% CI, 1.12-3.96), caesarian delivery (OR, 1.44; 95% CI, 1.26-1.64), and preterm birth (OR, 1.54; 95% CI, 1.29-1.83).
  
  
  CONCLUSIONS
  BPD is associated with several adverse obstetrical and neonatal outcomes. Hence, pregnant women who suffer from BPD should be monitored closely by a multidisciplinary health care team both before and during their pregnancies. This oversight would allow for the receipt of treatment for BPD and also interventions to help them to cease tobacco and drug use, which may ultimately decrease the incidence of poor obstetrical and neonatal outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Valerie
authors.initials: V
authors.lastname: Pare-Miron
authors.affiliation: Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Czuzoj-Shulman
authors.affiliation: Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Oddy
authors.affiliation: Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Andrea R
authors.initials: AR
authors.lastname: Spence
authors.affiliation: Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada. Electronic address: haim.abenhaim@gmail.com.
authors.forename: Haim Arie
authors.initials: HA
authors.lastname: Abenhaim
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology; D002585:Cesarean Section / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008603:Mental Health; D015999:Multivariate Analysis; D010552:Personality Assessment; D011247:Pregnancy / Q000523:psychology*; D011248:Pregnancy Complications / Q000523:psychology*; D011256:Pregnancy Outcome / Q000453:epidemiology / Q000523:psychology; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D055815:Young Adult