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

Abel Fekadu Dadi; Vincent He; Kiarna Brown; Karen Hazell-Raine; Nicole Reilly; Rebecca Giallo; Kym M Rae; Philip Hazell; Steven Guthridge

doi:10.1016/j.lanwpc.2024.101063

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

Lancet Reg Health West Pac. 2024 Apr 16:46:101063. doi: 10.1016/j.lanwpc.2024.101063. eCollection 2024 May.

Authors

Abel Fekadu Dadi^{1

2}, Vincent He¹, Kiarna Brown^{1

3}, Karen Hazell-Raine^{4

5}, Nicole Reilly^{6

7}, Rebecca Giallo⁸, Kym M Rae⁹, Philip Hazell^{10

11}, Steven Guthridge¹

Affiliations

¹ Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
² Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
³ Royal Darwin Hospital, Tiwi, NT 0810, Australia.
⁴ Faculty of Health, Charles Darwin University, Darwin, Australia.
⁵ Faculty of Medicine and Health, The University of Sydney, Australia.
⁶ Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney and St John of God Burwood Hospital, Sydney, Australia.
⁷ Faculty of Science, Medicine and Health, Graduate School of Medicine, University of Wollongong, Australia.
⁸ Faculty of Health, School of Psychology, Deakin University, Geelong, VIC, Australia.
⁹ Mater Research Institute, Aubigny Place, Raymond Terrace, South Brisbane, QLD, Australia.
¹⁰ School of Medicine, Charles Darwin University, Australia.
¹¹ School of Medicine, The University of Sydney, Australia.

Abstract

Background: Mental health conditions prior to or during pregnancy that are not addressed can have adverse consequences for pregnancy and birth outcomes. This study aimed to determine the extent to which women's mental health-related hospitalisation (MHrH) prior to or during pregnancy was associated with a risk of adverse birth outcomes.

Methods: We linked the perinatal data register for all births in the Northern Territory, Australia, from the year 1999 to 2017, to hospital admissions records to create a cohort of births to women aged 15-44 years with and without MHrH prior to or during pregnancy. We used Modified Poisson Regression and Latent Class Analysis to assess the association between maternal MHrH and adverse birth outcomes (i.e., stillbirth, preterm birth, low birth weight, and short birth length). We explored a mediation effect of covariates on theoretical causal paths. We calculated the adjusted Population Attributable Fraction (PAF) and Preventive Fractions for the Population (PFP) for valid associations.

Findings: From 72,518 births, 70,425 births (36.4% for Aboriginal women) were included in the analysis. The Latent Class Analys identified two classes: high (membership probability of 10.5%) and low adverse birth outcomes. Births to Aboriginal women with MHrH were around two times more likely to be in the class of high adverse birth outcomes. MHrH prior to or during pregnancy increased the risk of all adverse birth outcomes in both populations with risk ranging from 1.19 (95% CI: 1.05, 1.35) to 7.89 (1.17, 53.37). Eight or more antenatal care visits and intrauterine growth restriction mostly played a significant mediation role between maternal MHrH and adverse birth outcomes with mediation effects ranging from 1.04 (1.01, 1.08) to 1.39 (1.14, 1.69). MHrH had a low to high population impact with a PAF ranging from 16.1% (5.1%, 25.7%) to 87.3% (14.3%, 98.1%). Eight or above antenatal care visits avert extra adverse birth outcomes that range from 723 (332-765) stillbirths to 3003 (1972-4434) preterm births.

Interpretation: Maternal MHrH is a modifiable risk factor that explained a low to moderate risk of adverse birth outcomes in the Northern Territory. The knowledge highlights the need for the development and implementation of preconception mental health care into routine health services.

Funding: The Child and Youth Development Research Partnership (CYDRP) data repository is supported by a grant from the Northern Territory Government.

Keywords: Latent class analysis; Mental health-related hospitalization; PAF; PPF.