In a recent study published within the Lancet Psychiatry, researchers screened data of two million women aged ≥18 years registered in England’s National Health Service (NHS) to review the evidence on the consequences of pre-existing maternal mental health illnesses on increased risk of opposed obstetric and neonatal outcomes, comparable to preterm births, babies small for gestational age (SGA), stillbirth, and fetal and neonatal death in comparison with women and not using a history of mental illnesses.

Specifically, they stratified risks from composite indicators for neonatal opposed outcomes and maternal morbidity in keeping with the very best level of pre-pregnancy specialist mental health care sought by these women (as a proxy for the severity of illness).

Examples include psychiatric hospital admission, crisis resolution team (CRT) contact, or specialist community care contact, and the time of essentially the most recent care contact seven years before pregnancy. This helped the researchers distinguish pregnant women’s mental health histories.

Study: Obstetric and neonatal outcomes in pregnant women with and and not using a history of specialist mental health care: a national population-based cohort study using linked routinely collected data in England. Image Credit: Iryna Inshyna/Shutterstock.com

Background

Previously, multiple reviews investigating the consequences of mental illnesses in pregnant women and their impact on obstetric and neonatal outcomes in most administrative datasets have fetched incomplete and inconsistent evidence, especially for depressive disorders and anxiety.

This data is crucial to discover women almost definitely to profit from community perinatal mental health models of care integrated with midwifery care.

In regards to the study

In the current study, researchers searched the MEDLINE database from inception to May 21, 2023, to discover women with a gestation period of at the very least 24 weeks and who gave a singleton birth between April 1, 2014, and March 31, 2018, from the England NHS dataset.

Further, they categorized specialist mental healthcare experiences into the very best, middle, and lowest levels. In search of admission to a psychiatric ward was considered the very best level of care, and community-based care was the bottom level. Likewise, the team noted the time of most up-to-date mental healthcare contact, ranging between >5 to <1 yr before pregnancy.

Hospital Episode Statistics (HES) records all care episodes usually NHS hospitals. So, the researchers used HES data to know the maternal age, parity, ethnicity, and pre-existing morbidities.

They derived their socioeconomic deprivation status from rankings of the Index of Multiple Deprivation 2019 (IMD).

The England NHS maintains a national dataset of its specialist mental health care programs, which stays linked on the patient level to the HES and the private demographics service (PDS) birth notifications. This health service delivery data is collected routinely.

The first study outcomes were two composite opposed end result indicators capturing neonatal and maternal morbidity, preterm birth before 37 weeks of gestation, a baby born SGA, and neonatal death inside seven days of delivery.

Finally, the team used a logistic regression model to estimate odds ratios (ORs), adjusted ORs, and their 95% confidence intervals (CIs).

Results

Of the two,081,043 women constituting the analytic sample of this study, 151,770, i.e., 7·3%, at the very least once contacted a specialist mental health care before pregnancy onset. There have been 7,247 severe mental illness cases as they sought admission to a psychiatric hospital at the very least once. 29,770 and 114,753 women also had at the very least one CRT contact, and one specialist community contact, respectively.

Newer and one-on-one contact with specialist mental health care before pregnancy onset increased risks of opposed obstetric and neonatal outcomes as that reflected a more severe mental illness.

Intriguingly, these associations remained significant even after accounting for these women’s age, parity, ethnicity, maternal comorbidities, and socioeconomic status.

Conclusions

The UK’s National Health Service (NHS) has arrange specialist community perinatal mental health teams to offer care and counseling to women with severe mental illnesses. Women can seek these services within the pre-pregnancy, pregnancy, and postnatal periods. 

Nevertheless, moving forward, asking moms about contacting specialist mental healthcare services through the initial obstetric risk assessment or before the onset of pregnancy could help discover women at the very best risk and supply care to women with complex medical and social needs. 

To conclude, a timely and detailed causal mediation evaluation to evaluate a lady’s overall health is essential to stopping opposed obstetric and neonatal outcomes.