King's College London

New research from King’s College London 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 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 per cent in the group with SMIs (884.3 out of 100,000 in the group of women with SMI, 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.

This week also marked yesterday’s publication of the latest 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.

Mental illness affects around one in four women during early pregnancy. Women with mental illness, particularly those who experience serious mental illnesses (around 3 per cent) which require psychiatric support (i.e. beyond GP and IAPT therapy), are disproportionately affected by a range of poor fetal 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.

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 research was a 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.

This study is funded by the National Institute for Health Research.

For further information please contact Louise Pratt, Head of Communications, IoPPN: Louise.A.Pratt@kcl.ac.uk / +44 7850 919020

Obstetric near misses among women with serious mental illness: data linkage cohort study – Easter et al doi.org/10.1192/bjp.2020.250 is published in The British Journal of Psychiatry 11 January 2021.