Associations between pre-pregnancy psychosocial risk factors and infant outcomes: a population-based cohort study in England

Abstract

Summary Background Existing studies evaluating the association between maternal risk factors and specific infant outcomes such as birthweight, injury admissions, and mortality have mostly focused on single risk factors. We aimed to identify routinely recorded psychosocial characteristics of pregnant women most at risk of adverse infant outcomes to inform targeting of early intervention. Methods We created a cohort using administrative hospital data (Hospital Episode Statistics) for all births to mothers aged 15–44 years in England, UK, who gave birth on or after April 1, 2010, and who were discharged before or on March 31, 2015. We used generalised linear models to evaluate associations between psychosocial risk factors recorded in hospital records in the 2 years before the 20th week of pregnancy (ie, teenage motherhood, deprivation, pre-pregnancy hospital admissions for mental health or behavioural conditions, and pre-pregnancy hospital admissions for adversity, including drug or alcohol abuse, violence, and self-harm) and infant outcomes (ie, birthweight, unplanned admission for injury, or death from any cause, within 12 months from postnatal discharge). Findings Of 2 520 501 births initially assessed, 2 137 103 were eligible and were included in the birth outcome analysis. Among the eligible births, 93 279 (4·4%) were births to teenage mothers (age <20 years), 168 186 (7·9%) were births to previous teenage mothers, 51 312 (2·4%) were births to mothers who had a history of hospital admissions for mental health or behavioural conditions, 58 107 (2·7%) were births to mothers who had a history of hospital admissions for adversity, and 580 631 (27·2%) were births to mothers living in areas of high deprivation. 1 377 706 (64·5%) of births were to mothers with none of the above risk factors. Infants born to mothers with any of these risk factors had poorer outcomes than those born to mothers without these risk factors. Those born to mothers with a history of mental health or behavioural conditions were 124 g lighter (95% CI 114–134 g) than those born to mothers without these conditions. For teenage mothers compared with older mothers, 3·6% (95% CI 3·3–3·9%) more infants had an unplanned admission for injury, and there were 10·2 (95% CI 7·5–12·9) more deaths per 10 000 infants. Interpretation Health-care services should respond proactively to pre-pregnancy psychosocial risk factors. Our study demonstrates a need for effective interventions before, during, and after pregnancy to reduce the downstream burden on health services and prevent long-term adverse effects for children. Funding Wellcome Trust.

Perceptions and Practice of Preconception Care by Healthcare Workers and High-Risk Women in South Africa: A Qualitative Study

“…Although a study linking the effects of PCC in improving pregnancy outcomes was inconclusive, it revealed a relationship between PCC education and counselling with improved knowledge and control of risky behaviours [18]. Several psychosocial risk factors such as teenage birth, history of mental health, behavioural conditions, and living in deprived areas were associated with low birth weight and other adverse infant outcomes [19], which can be prevented through PCC.…”

Caring for Mothers: A Narrative Review on Interpersonal Violence and Peripartum Mental Health

“…Specific socioeconomic, behavioral, and clinical characteristics of pregnant women might make them more vulnerable to violence [ 9 ]. Health care services should respond proactively to pre-pregnancy psychosocial risk factors, and interventions should be multifaceted, delineate different types of violence, control for measurement reactivity, and design a tailored intervention program adjusted to the specific needs of couples experiencing interpersonal violence [ 11 , 12 , 58 ]. All mental health care professionals referring a woman to a maternity service should ensure that they communicate complete information on any past and present mental health problem.…”

“…Many adverse outcomes are associated with domestic violence during pregnancy: higher rates of preterm and low birth weight, poor reproductive health, unintended pregnancy, planned and spontaneous abortion, postnatal depression, and substance abuse [ 10 ]. A large population-based cohort study on more than 2 million mother–baby pairs in the UK showed that pre-pregnancy psychosocial risk factors (i.e., previous birth before 20 years of age, hospital contacts related to adversity or mental health or behavioral conditions, and deprivation) were associated with substantially increased risks of low birth weight, preterm birth, injury, and death during the 12 months from postnatal discharge [ 11 ].…”

Identifying adverse childhood experiences with electronic health records of linked mothers and children in England: a multistage development and validation study

“…37 The 20-week minimum cutoff before birth avoided exclusion of extreme preterm births and captured pre-birth data for the full cohort. 40 This study was approved by the UK Medicines and Healthcare products Regulatory Agency Independent Scientific Advisory Committee (19_162R), under Section 251 (NHS Social Care Act 2006), for the use of anonymised records in research without individual participant written consent.…”