Inequities and Missed Opportunities: A National Analysis of Emergency Department Visits for Pregnant Individuals with Mental Health and Substance Use Disorder.

Objective: This study aims to identify whether there are inequities in care for pregnant individuals with mental health or substance use disorders (MH/SUDs) seeking treatment in emergency departments (EDs) for pregnancy-related concerns. Considering their risk for poor maternal and infant outcomes, we sought to examine their experiences in EDs to target future interventions and institute referrals to integrated care systems. Methods: This retrospective, exploratory analysis identified ED visits for pregnancy-related concerns using the National Hospital Ambulatory Medical Care Survey database from 2016 to 2020 (n = 1,233) to compare experiences of care by pregnant people with (n = 149) and without MH/SUD (n = 1,084). Results: 11.9% (95% confidence interval [CI]: 9.8 - 15.1%) of ED visits for pregnancy-related concerns were cross-coded for MH/SUD. Compared to visits by pregnant individuals without MH/SUD, visits by pregnant people with MH/SUD were 70% less likely to be asked to return to the ED for follow-up treatment (p = 0.027), had 3.8 times greater odds of leaving the ED prior to completing care (p = 0.005), and received 40% more medication upon discharge (p = 0.049) after controlling for demographic variables. Of those visits by pregnant people with MH/SUD, only 6.8% were given a toxicology screen and only 1.2% were seen by an MH provider. Conclusion: This nationally representative analysis of ED visits for pregnancy-related concerns identified multiple opportunities to address care inequities that affect health outcomes. Special training and processes are needed within EDs to engage pregnant people with MH/SUD to provide effective, evidence-based care interventions and referrals.