Obstetric outcomes for women with severe mental illness: 10 years of experience in a tertiary multidisciplinary antenatal clinic

Jacqueline Frayne, Thinh Nguyen, Suzanna Allen, Yvonne Hauck, Helena Liira, Alistair Vickery

Research output: Contribution to journalArticle

Abstract

Purpose. This study aims to describe 10 years of antenatal care and outcomes for women with a severe mental illness (SMI).Methods. A retrospective cohort study of 420 completed pregnancy records over the last 10 years (2007–2017). Findings were compared to the Western Australian (WA) pregnancy data. Antenatal attendance, demographic, obstetric, neonatal and psychosocial variables were analysed using t tests, χ2, ANOVA and odds ratio (OR).Results. Overall, women with a SMI had high rates of comorbidity (47%), antenatal complications, and preterm birth at 12.6% compared to WA mothers (p < 0.001). Those with schizophrenia were at highest risk with increased risk of threatened preterm labour OR 8.25 (95% CI 4.64–14.65), gestational diabetes OR 3.59 (95% CI 2.18–5.91) and reduced likelihood of a spontaneous vaginal birth OR 0.46 (95% CI 0.29–0.71). Late presentation and antenatal attendance for women with SMI were significantly associated with maternal substance use, psychiatric admission during pregnancy, and child welfare involvement.Women with schizophrenia had significantly lower attendance rates at scheduled antenatal care (ANC) appointments than those with bipolar disease (87.1% vs 94%, p = 0.003).Conclusion. Obstetric outcomes are poorer for women with SMI compared to the general population. They have higher rates of medical comorbidities, lifestyle and psychosocial risks factors that are known to contribute to poor obstetric outcomes.Effective delivery of regular and appropriate ANC is essential in addressing these multifactorial risks. Targeted strategies addressing comprehensive medical management, preterm birth prevention, lifestyle modifications and increased psychosocial support could improve both short- and long-term outcomes for these women and their children.
Original languageEnglish
Pages (from-to)889-896
Number of pages8
JournalArchives of Gynecology and Obstetrics
Volume300
Issue number4
DOIs
Publication statusPublished - Oct 2019

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Obstetrics
Prenatal Care
Odds Ratio
Premature Birth
Pregnancy
Life Style
Comorbidity
Schizophrenia
Mothers
Gestational Diabetes
Premature Obstetric Labor
Child Welfare
Psychiatry
Analysis of Variance
Appointments and Schedules
Cohort Studies
Retrospective Studies
Demography
Parturition
Psychology

Cite this

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title = "Obstetric outcomes for women with severe mental illness: 10 years of experience in a tertiary multidisciplinary antenatal clinic",
abstract = "Purpose. This study aims to describe 10 years of antenatal care and outcomes for women with a severe mental illness (SMI).Methods. A retrospective cohort study of 420 completed pregnancy records over the last 10 years (2007–2017). Findings were compared to the Western Australian (WA) pregnancy data. Antenatal attendance, demographic, obstetric, neonatal and psychosocial variables were analysed using t tests, χ2, ANOVA and odds ratio (OR).Results. Overall, women with a SMI had high rates of comorbidity (47{\%}), antenatal complications, and preterm birth at 12.6{\%} compared to WA mothers (p < 0.001). Those with schizophrenia were at highest risk with increased risk of threatened preterm labour OR 8.25 (95{\%} CI 4.64–14.65), gestational diabetes OR 3.59 (95{\%} CI 2.18–5.91) and reduced likelihood of a spontaneous vaginal birth OR 0.46 (95{\%} CI 0.29–0.71). Late presentation and antenatal attendance for women with SMI were significantly associated with maternal substance use, psychiatric admission during pregnancy, and child welfare involvement.Women with schizophrenia had significantly lower attendance rates at scheduled antenatal care (ANC) appointments than those with bipolar disease (87.1{\%} vs 94{\%}, p = 0.003).Conclusion. Obstetric outcomes are poorer for women with SMI compared to the general population. They have higher rates of medical comorbidities, lifestyle and psychosocial risks factors that are known to contribute to poor obstetric outcomes.Effective delivery of regular and appropriate ANC is essential in addressing these multifactorial risks. Targeted strategies addressing comprehensive medical management, preterm birth prevention, lifestyle modifications and increased psychosocial support could improve both short- and long-term outcomes for these women and their children.",
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Obstetric outcomes for women with severe mental illness : 10 years of experience in a tertiary multidisciplinary antenatal clinic. / Frayne, Jacqueline; Nguyen, Thinh; Allen, Suzanna; Hauck, Yvonne; Liira, Helena; Vickery, Alistair.

In: Archives of Gynecology and Obstetrics, Vol. 300, No. 4, 10.2019, p. 889-896.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Obstetric outcomes for women with severe mental illness

T2 - 10 years of experience in a tertiary multidisciplinary antenatal clinic

AU - Frayne, Jacqueline

AU - Nguyen, Thinh

AU - Allen, Suzanna

AU - Hauck, Yvonne

AU - Liira, Helena

AU - Vickery, Alistair

PY - 2019/10

Y1 - 2019/10

N2 - Purpose. This study aims to describe 10 years of antenatal care and outcomes for women with a severe mental illness (SMI).Methods. A retrospective cohort study of 420 completed pregnancy records over the last 10 years (2007–2017). Findings were compared to the Western Australian (WA) pregnancy data. Antenatal attendance, demographic, obstetric, neonatal and psychosocial variables were analysed using t tests, χ2, ANOVA and odds ratio (OR).Results. Overall, women with a SMI had high rates of comorbidity (47%), antenatal complications, and preterm birth at 12.6% compared to WA mothers (p < 0.001). Those with schizophrenia were at highest risk with increased risk of threatened preterm labour OR 8.25 (95% CI 4.64–14.65), gestational diabetes OR 3.59 (95% CI 2.18–5.91) and reduced likelihood of a spontaneous vaginal birth OR 0.46 (95% CI 0.29–0.71). Late presentation and antenatal attendance for women with SMI were significantly associated with maternal substance use, psychiatric admission during pregnancy, and child welfare involvement.Women with schizophrenia had significantly lower attendance rates at scheduled antenatal care (ANC) appointments than those with bipolar disease (87.1% vs 94%, p = 0.003).Conclusion. Obstetric outcomes are poorer for women with SMI compared to the general population. They have higher rates of medical comorbidities, lifestyle and psychosocial risks factors that are known to contribute to poor obstetric outcomes.Effective delivery of regular and appropriate ANC is essential in addressing these multifactorial risks. Targeted strategies addressing comprehensive medical management, preterm birth prevention, lifestyle modifications and increased psychosocial support could improve both short- and long-term outcomes for these women and their children.

AB - Purpose. This study aims to describe 10 years of antenatal care and outcomes for women with a severe mental illness (SMI).Methods. A retrospective cohort study of 420 completed pregnancy records over the last 10 years (2007–2017). Findings were compared to the Western Australian (WA) pregnancy data. Antenatal attendance, demographic, obstetric, neonatal and psychosocial variables were analysed using t tests, χ2, ANOVA and odds ratio (OR).Results. Overall, women with a SMI had high rates of comorbidity (47%), antenatal complications, and preterm birth at 12.6% compared to WA mothers (p < 0.001). Those with schizophrenia were at highest risk with increased risk of threatened preterm labour OR 8.25 (95% CI 4.64–14.65), gestational diabetes OR 3.59 (95% CI 2.18–5.91) and reduced likelihood of a spontaneous vaginal birth OR 0.46 (95% CI 0.29–0.71). Late presentation and antenatal attendance for women with SMI were significantly associated with maternal substance use, psychiatric admission during pregnancy, and child welfare involvement.Women with schizophrenia had significantly lower attendance rates at scheduled antenatal care (ANC) appointments than those with bipolar disease (87.1% vs 94%, p = 0.003).Conclusion. Obstetric outcomes are poorer for women with SMI compared to the general population. They have higher rates of medical comorbidities, lifestyle and psychosocial risks factors that are known to contribute to poor obstetric outcomes.Effective delivery of regular and appropriate ANC is essential in addressing these multifactorial risks. Targeted strategies addressing comprehensive medical management, preterm birth prevention, lifestyle modifications and increased psychosocial support could improve both short- and long-term outcomes for these women and their children.

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DO - 10.1007/s00404-019-05258-x

M3 - Article

VL - 300

SP - 889

EP - 896

JO - Archives of Gynecology and Obstetrics

JF - Archives of Gynecology and Obstetrics

SN - 0932-0067

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ER -