Obstetric and neonatal outcomes in pregnant women with and without a history of specialist mental healthcare: a national population-based cohort study using linked routinely collected data in England.
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Abstract
Background: Pregnant women with pre-existing mental illness have increased risks of adverse obstetric and neonatal outcomes. We estimated these difference in risks according to the highest level of pre-pregnancy specialist mental healthcare, defined as psychiatric hospital admission, crisis resolution team (CRT) contact, or specialist community care only, and the timing of the most recent care episode within 7 years before pregnancy.
Methods: Hospital and birth registration records of women with singleton births between 2014 and 2018 in England were linked to records of babies and records from specialist mental health services, provided by the English National Health Service, a publicly funded healthcare system. Composite indicators captured neonatal adverse outcomes and maternal morbidity. We calculated odds ratios (ORs), adjusted for maternal characteristics.
Outcomes: Of 2,081,043 included women (mean age 30.0 years; range 18 to 55 years; 77.7% White, 11.1% South Asian, 4.7% Black and 6.2% other ethnic background), 151,770 (7·3%) had at least one pre-pregnancy specialist mental healthcare contact. 7,247 (0·3%) had been admitted, 29,770 (1·4%) had CRT contact, and 114,753 (5·5%) had community care only. With a pre-pregnancy mental healthcare contact, risk of stillbirth or neonatal death within seven days was not significantly increased (0·45% to 0·49%; OR 1·11, 95%CI 0·99–1·24). Risk of preterm birth (<37 weeks) increased (6·5% to 9·8%; OR 1·53, 1·35–1·73) as did risk of small for gestational age (birthweight <10th percentile) (6·2% to 7·5%; OR 1·34, 1·30–1·37), and neonatal adverse outcomes (6·4% to 8·4%; OR 1·37, 1·21–1·55). With a pre-pregnancy mental healthcare contact, maternal morbidity increased slightly from 0·9% to 1·0% (OR 1·18, 1·12–1·25). Overall, risks were highest for women who had a psychiatric hospital admission any time or a mental healthcare contact in the year before pregnancy.
Interpretation: Information about level and timing of pre-pregnancy specialist mental healthcare contacts can support identifying pregnant women at increased risk of adverse obstetric and neonatal outcomes, most likely to benefit from integrated perinatal mental health and obstetric care.