Population Health Research Net

DATA LINKAGE CASE STUDY

Pregnancy and birth complications in mothers with serious mental illness

Overview:

About one in five Australians will experience a mental illness at some time in their lives. A mental illness is a health problem that significantly affects how a person feels, thinks, behaves, and interacts with other people. It is diagnosed according to standardised criteria.

Mental illnesses are of different types and degrees of severity. Some of the major types are depression, anxiety, schizophrenia, bipolar mood disorder, personality disorders and eating disorders.

There are many studies showing that people with mental illness are at greater risk
of having other health problems. In addition, the children of people with mental illness are also more likely to have poorer mental health and other health outcomes than those children born to healthy parents. These observations from around the globe prompted a group of researchers in Western Australia to investigate why the children of people with mental illness have poorer health ⁽¹⁾.

What data were used to perform the study?

The researchers linked together the health information from 1,831 women in Western Australia who had schizophrenia or a major mood disorder with the health records of their children. These records were compared with the records from children whose mothers did not have a mental illness. Identities were removed from all information.

What were the results of the study?

The main findings were:

• The mothers with mental illness had an increased risk of complications in pregnancy, birth and soon after birth, including placental abnormalities, bleeding during later pregnancy and fetal distress during labour

• Mothers with schizophrenia were significantly more likely to have babies with a low birth weight, and to have children with cardiovascular birth defects

• Complications other than low birth weight and birth defects were higher in pregnancies that occurred after a diagnosis of mental illness than in pregnancies before the mother's diagnosis

• Compared with mothers with no mental illness, mothers with diagnosed schizophrenia were more likely to be younger than 20 or older than 35 at the time of birth of their child, of lower socioeconomic status, lacking adequate social support and less likely to access antenatal and postnatal care.

What did the authors conclude from their results?

The study concluded that better programs were needed to ensure that mothers with a mental illness receive better care before and after their pregnancies to reduce the chances of complications. Further research aimed at understanding the genetic and environmental risks in this particularly vulnerable group could pave the way to improve the health of the children of mothers with mental illness.

What has happened since this study was published?

As many of these women continue their contact with mental health care services, it was recommended that community mental health care workers would be best placed to assist them.

A second group of WA researchers determined that healthcare workers required better information and strategies to use when treating pregnant mothers with a serious mental illness ⁽²⁾.

Consultations were undertaken with mental health clinicians, midwives, psychiatrists, GPs and community mental health nurses. Two mothers with serious mental illness were also asked to provide their experiences. A toolkit was then developed which identified factors where intervention is possible, such as early and ongoing antenatal care attendance, smoking moderation or cessation, nutritional advice and links to appropriate support services at the earliest opportunity.

The toolkit was launched in Western Australia in July 2008. There are plans to follow‐up on mothers with serious mental illness to determine the impact of the toolkit on pregnancy and birth outcomes.

¹ Jablensky AV, Morgan V, Zubrick SR, Bower C, Yellachich L.. Pregnancy, Delivery, and Neonatal Complications in a Population Cohort of Women With Schizophrenia and Major Affective Disorders. Am J Psychiatry 2005; 162:79-91

² Hauck Y, Rock D, Jackiewicz T, Jablensky A.  Healthy Babies for Mothers with Serious Mental Illness: A case management framework for clinicians.  Int J  Ment Hlth Nurs (2008) 17, 383-391