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, show 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 saw the publication of the latest confidential enquiry into maternal deaths in the UK, 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.

This study sheds important light on the physical and mental health challenges faced by women before, during and after pregnancy. By increasing our understanding of how pre-existing conditions can influence mother and child health outcomes and by not assuming physical symptoms are due to a mental health condition, we can improve outcomes for women with serious mental illnesses

Abigail Easter

Lead author of the paper, Dr Abigail Easter, King’s College London, based in the ARC’s maternity and perinatal mental health theme

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 (ie 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 people with severe mental illness experiencing more health problems and shorter life-expectancies is well-documented, with life-expectancy approximately 10-20 years less that the general population, among both males and females.

In addition to the contribution of such health disparities, questions around maternal mortality have highlighted a concept known as “diagnostic overshadowing” as a potential factor in maternal deaths. This is where women who have died of physical complications have had their symptoms misattributed to mental illness.

Poor care during childbirth and inadequate prenatal care may also contribute to the risk of severe obstetric complications among women with mental illness.

Reducing maternal morbidity and mortality is a key international development goal. Effective interventions that target vulnerable groups, including women with severe mental illness, are vital to achieving this goal

Louise Howard

Senior author, Professor Louise Howard, King’s College London, based in the ARC’s maternity and perinatal mental health theme

Professor Howard 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 study was funded by the National Institute for Health Research.