Obstetric and neonatal outcomes in pregnant women with and without a history of specialist mental health care: a national population-based cohort study using linked routinely collected data in England.

Autor:	Langham J; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Royal College of Obstetricians and Gynaecologists, London, UK., Gurol-Urganci I; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Royal College of Obstetricians and Gynaecologists, London, UK., Muller P; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Royal College of Obstetricians and Gynaecologists, London, UK., Webster K; Royal College of Obstetricians and Gynaecologists, London, UK., Tassie E; King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK., Heslin M; King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK., Byford S; King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK., Khalil A; Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's University Hospitals, NHS Foundation Trust, London, UK; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK., Harris T; Centre for Reproduction Research, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK., Sharp H; Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK., Pasupathy D; Department of Women and Children's Health, King's College London, London, UK; Reproduction and Perinatal Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia., van der Meulen J; Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Royal College of Obstetricians and Gynaecologists, London, UK. Electronic address: jan.vandermeulen@lshtm.ac.uk., Howard LM; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK., O'Mahen HA; Washington Singer Laboratories, University of Exeter, Exeter, UK.
Jazyk:	angličtina
Zdroj:	The lancet. Psychiatry [Lancet Psychiatry] 2023 Oct; Vol. 10 (10), pp. 748-759. Date of Electronic Publication: 2023 Aug 14.
DOI:	10.1016/S2215-0366(23)00200-6
Abstrakt:	Background: Pregnant women with pre-existing mental illnesses have increased risks of adverse obstetric and neonatal outcomes compared with pregnant women without pre-existing mental illnesses. We aimed to estimate these differences in risks according to the highest level of pre-pregnancy specialist mental health care, defined as psychiatric hospital admission, crisis resolution team (CRT) contact, or specialist community care only, and the timing of the most recent care episode in the 7 years before pregnancy. Methods: Hospital and birth registration records of women with singleton births between April 1, 2014, and March 31, 2018 in England were linked to records of babies and records from specialist mental health services provided by the England National Health Service, a publicly funded health-care system. We compared the risks of adverse pregnancy outcomes, including fetal and neonatal death, preterm birth, and babies being born small for gestational age (SGA; birthweight <10th percentile), and composite indicators for neonatal adverse outcomes and maternal morbidity, between women with and without a history of contact with specialist mental health care. We calculated odds ratios adjusted for maternal characteristics (aORs), using logistic regression. Findings: Of 2 081 043 included women (mean age 30·0 years; range 18-55 years; 77·7% White, 11·4% South Asian, 4·7% Black, and 6·2% mixed or other ethnic background), 151 770 (7·3%) had at least one pre-pregnancy specialist mental health-care contact. 7247 (0·3%) had been admitted to a psychiatric hospital, 29 770 (1·4%) had CRT contact, and 114 753 (5·5%) had community care only. With a pre-pregnancy mental health-care contact, risk of stillbirth or neonatal death within 7 days of birth was not significantly increased (0·45-0·49%; aOR 1·11, 95% CI 0·99-1·24): risk of preterm birth (<37 weeks) increased (6·5-9·8%; aOR 1·53, 1·35-1·73), as did risk of SGA (6·2- 7·5%; aOR 1·34, 1·30-1·37) and neonatal adverse outcomes (6·4-8·4%; aOR 1·37, 1·21-1·55). With a pre-pregnancy mental health-care contact, risk of maternal morbidity increased slightly from 0·9% to 1·0% (aOR 1·18, 1·12-1·25). Overall, risks were highest for women who had a psychiatric hospital admission any time or a mental health-care contact in the year before pregnancy. Interpretation: Information about the level and timing of pre-pregnancy specialist mental health-care contacts helps to identify women at increased risk of adverse obstetric and neonatal outcomes. These women are most likely to benefit from dedicated community perinatal mental health teams working closely with maternity services to provide integrated care. Funding: National Institute for Health Research. Competing Interests: Declaration of interests LMH, HAO'M, JvdM, SB, DP, and HS declare funding from the National Institute of Health Research to deliver a study on the effectiveness of community perinatal mental health services (17/49/38). AK, TH, IG-U, and JvdM also declare funding from the Healthcare Quality Improvement Partnership to deliver the National Maternity and Perinatal Audit. All other authors declare no competing interests. (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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