Obstetric near misses among women with serious mental illness: data linkage cohort study

TY - JOUR

T1 - Obstetric near misses among women with serious mental illness

T2 - data linkage cohort study

AU - Easter, Abigail

AU - Sandall, Jane

AU - Howard, Louise M

N1 - Funding Information: This study is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King's College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. L.M.H. was funded through an NIHR Research Professorship (NIHR-RP-R3-12-011) in maternal mental health. J.S. and L.M.H. recieve funding from the NIHR as NIHR Senior Investigators. Publisher Copyright: Copyright © The Authors, 2021. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/9

Y1 - 2021/9

N2 - Background Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. Aims To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). Method 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). Results 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). Conclusions Findings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI.

AB - Background Investigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity. Aims To investigate the rate and type of obstetric near misses among women with serious mental illness (SMI). Method 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). Results 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). Conclusions Findings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI.

UR - http://www.scopus.com/inward/record.url?scp=85105288625&partnerID=8YFLogxK

U2 - 10.1192/bjp.2020.250

DO - 10.1192/bjp.2020.250

M3 - Article

C2 - 33427147

SN - 0007-1250

VL - 219

SP - 494

EP - 500

JO - The British journal of psychiatry : the journal of mental science

JF - The British journal of psychiatry : the journal of mental science

IS - 3

ER -