Perinatal outcomes of Aboriginal women with mental health disorders

Abstract

Objective: Maternal mental disorders have been associated with adverse perinatal outcomes such as low birthweight and preterm birth, although these links have been examined rarely among Australian Aboriginal populations. We aimed to evaluate the association between maternal mental disorders and adverse perinatal outcomes among Aboriginal births. Methods: We used whole population-based linked data to conduct a retrospective cohort study ( N = 38,592) using all Western Australia singleton Aboriginal births (1990–2015). Maternal mental disorders were identified based on the International Classification of Diseases diagnoses and grouped into six broad diagnostic categories. The perinatal outcomes evaluated were preterm birth, small for gestational age, perinatal death, major congenital anomalies, foetal distress, low birthweight and 5-minute Apgar score. We employed log-binomial/-Poisson models to calculate risk ratios and 95% confidence intervals. Results: After adjustment for sociodemographic factors and pre-existing medical conditions, having a maternal mental disorder in the five years before the birth was associated with adverse perinatal outcomes, with risk ratios (95% confidence intervals) ranging from 1.26 [1.17, 1.36] for foetal distress to 2.00 [1.87, 2.15] for low birthweight. We found similar associations for each maternal mental illness category and neonatal outcomes, with slightly stronger associations when maternal mental illnesses were reported within 1 year rather than 5 years before birth and for substance use disorder. Conclusions: This large population-based study demonstrated an increased risk of several adverse birth outcomes among Aboriginal women with mental disorders. Holistic perinatal care, treatment and support for women with mental disorders may reduce the burden of adverse birth outcomes.

Association between maternal mental health-related hospitalisation in the 5 years prior to or during pregnancy and adverse birth outcomes: a population-based retrospective cohort data linkage study in the Northern Territory of Australia

“… 36 , 37 Prior evidence regarding the association between maternal MHrH and SB is inconsistent. 13 , 34 Our study finding substantiates those findings that reported association between maternal MHrH and SB. Infant birth length is the strongest predictor of linear growth status in early childhood 38 where the link between maternal mental health condition and birth length has never been explored.…”

“…Our study replicates previous findings that maternal MHrH before or during pregnancy increases the risk of PTB and LBW in both non-Aboriginal and Aboriginal women. 5 , 6 , 13 , 34 We propose four potential pathways to explain this link: i) MHrH effects are mediated by obstetric complications leading to adverse birth outcomes; ii) Women with psychiatric diagnoses are more likely to engage in behaviours such as smoking and alcohol consumption during pregnancy, which can lead to poor fetal growth and subsequent adverse birth outcomes; iii) Biological and hormonal pathways involving psychiatric symptoms lead to elevated cortisol production or plasminogen activator inhibitor 1 (PAI-1), which can adversely alter the intrauterine environment and contribute to adverse birth outcomes 35 ; and iv) mental health disorders affects maternal health service uptake including ANC—our study demonstrated that ANC service attendance mediated most of the paths from pre-pregnancy maternal MHrH to adverse birth outcomes —and attending at least eight ANC service demonstrated to prevent a significant number of adverse birth outcomes. 36 , 37 Prior evidence regarding the association between maternal MHrH and SB is inconsistent.…”

“…11 Limited studies in Australia have reported on perinatal outcomes associated with severe mental illnesses during pregnancy, with one study specifically focusing on First Nations Australians. 2 , 12 , 13 Australia's First Nations communities are made up of Aboriginal and Torres Strait Islander populations, which we interchangeably use Aboriginal population throughout the paper. No study investigated the burden and risk of maternal mental health-related hospitalisation (MHrH) before or during pregnancy on adverse birth outcomes in the Northern Territory where the burden and consequences are expected to be higher than in the other states.…”