Abstract Body (Do not enter title and authors here): Introduction
Serious mental illness (SMI), defined as schizophrenia, major depressive disorder, or bipolar disorder, has been associated with an increased risk of a variety of adverse maternal and fetal outcomes. Research has demonstrated a higher comorbidity burden in these patients, including obesity, T2DM, epilepsy, thyroid disease, and substance use disorders. We attempted to investigate the risk for adverse maternal cardiovascular outcomes in patients with SMI while controlling for comorbidity burden.

Methods
Using the National Inpatient Sample from 2020 to 2022, we retrospectively identified patients ≥18 years of age who were admitted for a childbirth. Patients hospitalized for abortions, ectopic pregnancy, and stillbirths were excluded. Baseline characteristics were compared using t-tests. A multivariable logistic regression model with a 2-sided significance level of 0.05 was used.

Results
A total of 10,425,907 deliveries were included in the analysis, of which 700,852 (6.7%) occurred in patients with serious mental illness (SMI). The specific SMI diagnosis and overall distribution are given in image-1. The SMI group had a higher prevalence of comorbidities, including systemic HTN, T2DM, CAD, systolic/diastolic HF, COPD, and CKD 3-5. The mean maternal age was similar between groups. The baseline characteristics are given in image-2. Multivariate analysis was run after adjusting for all baseline characteristics. SMI was associated with an increased odds of post/peripartum cardiomyopathy (aOR 2.28, 95% CI 1.76–2.95, p<0.001), post-delivery shock (aOR 1.66, 95% CI 1.47–1.86, p<0.001), acute systolic or diastolic HF exacerbation (aOR 2.08, 95% CI 1.49–2.89, p<0.001), and paroxysmal tachycardia or atrial fib/flutter (aOR 2.24, 95% CI 1.68–2.98, p<0.001). Cardiogenic shock showed a trend toward significance (aOR 1.81, 95% CI 0.96–3.41, p=0.066). There was no significant association with maternal inpatient mortality or acute right heart failure. Spontaneous coronary artery dissection was omitted from analysis due to zero events in the SMI group.

Conclusion
Serious mental illness is independently associated with increased odds of adverse maternal cardiovascular outcomes. This analysis is limited to inpatient data; we could not assess outcomes following hospital discharge. Additional cases of delayed post-partum cardiomyopathy and other complications may have occurred after discharge, which were unable to be captured.