Abstract
Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). We conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort - all women with a live or still birth in 2007-2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort - all women with a live or still birth in 2007-2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274). The rate of obstetric near misses was 884.3/100 000 (95% CI 733.2-1057.4) maternities in the exposed group compared with 575.1/100 000 (95% CI 544.0-607.4) maternities in the unexposed group (adjusted odds ratio 1.6, 95% CI 1.3-2.0, P < 0.001). Highest risks were for acute renal failure (adjusted odds ratio 2.1, 95% CI 1.1-3.8, P = 0.022); cardiac arrest, failure or infarction (adjusted odds ratio 2.3, 95% CI 1.1-4.8, P = 0.028); and obstetric embolism (adjusted odds ratio 3.1, 95% CI 1.6-5.8, P < 0.001). Findings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI.
Highlights
Investigating obstetric near misses provides crucial information to prevent maternal mortality and morbidity
F30–F39); anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders (ICD-10 codes F40–F48); behavioural syndromes associated with physiological disturbances and physical factors (ICD-10 codes F50–F59); disorders of adult personality and behaviour (ICD-10 codes F60–F69); intellectual disabilities (ICD-10 codes F70–F79); pervasive and specific developmental disorders (ICD-10 codes F80–F89); behavioural and emotional disorders with onset usually occurring in childhood and adolescence (ICD-10 codes F90–F98); and unspecified mental disorder (ICD-10 code F99)
This study aimed to investigate severe obstetric complications of childbirth among women with and without serious mental illness (SMI); acute psychosis recorded during the childbirth episode, which was included within the original English Maternal Morbidity Outcome Indicator (EMMOI) composite, was not included within the total composite indicator in this analysis of obstetric near misses
Summary
We conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort – all women with a live or still birth in 2007–2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort – all women with a live or still birth in 2007–2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274). Using linked routine electronic healthcare records on maternity data from hospital admissions and secondary mental healthcare (i.e. specialist in-patient or out-patient mental healthcare for serious or chronic mental illness) in the UK, we aimed to investigate the rate and characteristics of obstetric near misses among women with SMI (i.e. women with a current or history of treatment within secondary mental health services)
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