Abstract
BackgroundWomen with Severe Mental Illness (SMI) may have more complex pregnancies and pregnancy outcomes that require different care and management, but this has not been extensively studied. The aim of this study was to explore associations between SMI and adverse maternal and infant outcomes in the state of Victoria, Australia.MethodsOur sample included all reported live singleton births in Victoria 2009–2016 (N = 595 792). Associations between SMI and adverse pregnancy outcomes were explored using Odds Ratios (OR), adjusted for sociodemographic and lifestyle factors, and co-morbidities, including any other mental illness.ResultsOf all singleton births, 2046 (0.34%) were to a mother diagnosed with a SMI. We found evidence of an association between SMI and a range of adverse maternal and infant outcomes. Compared to women without SMI, women with a SMI had higher adjusted odds of being admitted to a High Dependency Unit or Intensive Care Unit (aOR 1.83, 1.37–2.43), having gestational diabetes mellitus (1.57, 1.34–1.84), undergoing an unplanned caesarean section (1.17, 1.02–1.33), induction of labour (1.17, 1.05–1.30) and postpartum haemorrhage (1.15, 1.03–1.29). Newborns of women with SMI had higher adjusted odds of being admitted to Special Care Nursery (aOR 1.61, 1.43–1.80), a low Apgar score at 5 minutes (1.50, 1.19–1.90), preterm birth (1.40, 1.20–1.63), and low birthweight (1.26, 1.06–1.49).ConclusionWomen with SMI are at higher risk for a range of adverse maternal and infant outcomes and are a population that may benefit from targeted early identification and enhanced antenatal care.
Highlights
The health status of women prior to them becoming pregnant and their health behaviors during pregnancy are established predictors for pregnancy outcomes [1]
We found evidence of an association between Severe Mental Illness (SMI) and a range of adverse maternal and infant outcomes
There were 595 792 singleton infants born in Victoria between 2009 and 2016, of which 2046 (0.34%) were to a mother with a SMI: 29% had an ICD F20-F29 [schizophrenia and related disorder] and 71% ICD F30-F31 [mood disorders] diagnosis
Summary
The health status of women prior to them becoming pregnant and their health behaviors during pregnancy are established predictors for pregnancy outcomes [1]. People with Severe Mental Illness (SMI)–schizophrenia, bipolar disorder and major depressive disorder–more commonly have a complex set of risk factors for ill health and excess comorbidity [2–4], which is mirrored in an estimated 8–17.5 year mortality gap between people with SMI and the general population [5–7]. Little attention has been given to the reproductive health of women with SMI. Fertility rates have been low among women with SMI such as schizophrenia [8]. Some authors argue there has been little change in fertility rates over time for women with SMI [9]. There is emerging evidence suggesting an increase in fertility rates in women with schizophrenia, that are comparable with the general population [10]. Women with Severe Mental Illness (SMI) may have more complex pregnancies and pregnancy outcomes that require different care and management, but this has not been extensively studied. The aim of this study was to explore associations between SMI and adverse maternal and infant outcomes in the state of Victoria, Australia
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