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259 Postpartum emergency department usage among women with psychiatric illness Ilina Datkhaeva, Connie C. Lee, Kerry Holliman, Yalda Afshar, Tina Nguyen, Christina S. Han, Deborah Krakow, Rashmi Rao Division of MFM, Dept. of Obstetrics and Gynecology, UCLA, Los Angeles, CA, Faculty Practice Group, Office of Population Health and Accountable Care, UCLA, Los Angeles, CA, Division of MFM, Dept of Obstetrics and Gynecology, UCLA, Los Angeles, CA, Center for Fetal Medicine and Women’s Ultrasound, Los Angeles, CA OBJECTIVE: To investigate postpartum emergency department (ED) usage among women with psychiatric illness (PI) during pregnancy. STUDY DESIGN: Hospital administrative data at a large academic center was collected for a retrospective cohort study of ED usage among pregnant and postpartum women with or without PI. Demographic and outcome data was chart abstracted and analyzed using Student’s t-test and Fisher exact tests. RESULTS: Of 15,112 births between January 2014 to June 2018, 2,635 (17.4%) were among women with documented underlying PI (51% anxiety, 34% depression, 11% substance abuse, 3% bipolar and 1% psychosis). A total of 613 women in this birth cohort utilized the ED within thirty days of delivery and 29.3% (180) had underlying PI. Among women with PI, 6.8% (180/2,635) utilized the ED within 30 days of their delivery compared to 3.5% (433/12,477) of patients without PI (p<0.01). Compared to women without PI, women with underlying PI had more usage for psychiatric causes (5.0% vs. 0.2%, p<0.01) and for non-obstetric causes (25.6% vs. 21.9%, p<0.01), but similar usage for the common obstetric complaints (infection or pain 22.8% vs. 25.8%, hypertension 14.4% vs. 12.0%, and vaginal bleeding 10.6% vs. 8.5%, p1⁄40.08). Among patients with PI, those that utilized the ED were more likely to be nonHispanic black (15.0% vs. 6.6, p1⁄40.004), have a higher body mass index (32.1 vs. 29.9 kg/m, p <0.01) and have undergone a cesarean delivery (49.4% vs. 36.3%, p1⁄4<0.01). There were equal distributions of types of PI among the ED users and non-users and no difference in rates of preterm delivery. (Table 1) Of the entire cohort, there were thirteen patients with psychiatric admissions, all among women with underlying PI (0.5%; 13/2,635). CONCLUSION: Women with psychiatric illness utilize the emergency department postpartum twice as frequently as women without psychiatric illness for psychiatric and non-obstetric reasons. Ongoing pregnancy and early postpartum evaluation may be warranted for this high-risk population.