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

  • Jacqueline FrayneEmail author
  • Thinh Nguyen
  • Suzanna Allen
  • Yvonne Hauck
  • Helena Liira
  • Alistair Vickery
Maternal-Fetal Medicine
  • 26 Downloads

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.

Keywords

Antenatal care Severe mental illness Schizophrenia Bipolar 

Notes

Author contributions

JF: project development, data collection and analysis, manuscript writing and editing. TN: project development, manuscript writing and editing. SA: data collection and manuscript editing. YH: project development, manuscript writing and editing. HL: project development, manuscript writing and editing. AV: manuscript writing and editing.

Funding

No funding was involved in this study.

Compliance with ethical standards

Conflict of interest

The authors declare they have no conflicts of interest.

Research involving human participants

Ethical approval was granted from the hospital Human Research Ethics Committee (2018005QK) and carried out in accordance with The National Statement on Ethical Conduct in Human Research.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyWomen and Newborn Health ServiceSubiacoAustralia
  2. 2.Division of General Practice, School of Medicine, Faculty of Health and Medical SciencesThe University of Western AustraliaCrawleyAustralia
  3. 3.Division of Psychiatry, School of Medicine, Faculty of Health and Medical SciencesThe University of Western AustraliaCrawleyAustralia
  4. 4.Peel and Rockingham Kwinana Mental Health ServicesKwinanaAustralia
  5. 5.Department of Nursing and Midwifery EducationWomen and Newborn Health ServiceSubiacoAustralia
  6. 6.School of Nursing, Midwifery and ParamedicineCurtin UniversityPerthAustralia
  7. 7.General PracticeUniversity of HelsinkiHelsinkiFinland

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