Serious mental illness during pregnancy poses greater physical health risks

Research finds women with serious mental illnesses that require specialist care are more likely to have life-threatening physical health complications.

pregnancyNew research conducted in collaboration between King’s College London and the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust shows that women with serious mental illnesses (SMI) which required specialist care were more likely to have a ‘near-miss’ life-threatening obstetric complication such as kidney failure, heart attacks or embolisms, blood clotting, during childbirth.

Results from a data linkage anonymised cohort study of over 200,000 women who gave birth between 2007-2016, published this week in the British Journal of Psychiatry, shows the additional physical risks that pregnant women with mental health conditions face.

Severe, potentially life threatening, obstetric complications increased by 50 % in the group with SMIs (884.3 out of 100,000 in the group of women with SMIs, compared with 575.1 out of 100,000 in pregnant women in the general population). Highest risks were observed for acute kidney failure, cardiac arrest, heart failure or heart attacks, and obstetric embolism after adjusting for maternal age, ethnicity and social deprivation.

Lead author, Dr Abigail Easter from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, said:

This study sheds important light on the physical and mental health challenges faced by women before, during and after pregnancy. By increasing our understanding of how pre-existing conditions can influence mother and child health outcomes and by not assuming physical symptoms are due to a mental health condition, we can improve outcomes for women with serious mental illnesses.

Mental illness affects around one in four women during early pregnancy. Women with mental illness, particularly those who experience serious mental illnesses (around 3 %) which require psychiatric support (such as beyond GP and Improving Access to Psychological Therapies (IAPT) therapy), are disproportionately affected by a range of poor foetal and maternal outcomes.

These outcomes can include premature birth and low birth weight, as well as an increased risk of the mother dying. As the maternal mortality rate decreases, this study provides crucial information to prevent deaths and serious conditions by investigating maternal life-threatening obstetric complications.

The evidence for more health problems and shorter life-expectancies for people with mental illness is well documented, and life expectancy is approximately 10-20 years earlier that the general population, among both males and females.

Senior author, Prof Louise Howard from King’s College London, said:

Reducing maternal morbidity and mortality is a key international development goal. Effective interventions that target vulnerable groups, including women with severe mental illness, are vital to achieving this goal.

She added:

We need to take an integrated approach to prevention and treatment of problems in pregnancy, integrating both physical and mental health. This should include addressing mental and physical health, and associated social determinants of health such as poverty, domestic violence and other inequalities (currently being exacerbated by the pandemic), at critical life stages, both before conception and during pregnancy.

This study is funded by the NIHR.

The latest MBRACE-UK confidential enquiry into maternal deaths which highlighted that almost all of the women who have died during childbirth had multiple problems such as pre-existing physical and mental health conditions was also published recently.

The vision for our Women and Children's Health Institute is to be a centre for excellence in women and children’s health.  We will improve outcomes locally, nationally and globally in childhood and on into adulthood, with an integrated mind and body approach, in the context of family and community.

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