Using linked data to assess maternal mental and behavioural disorders in pregnancy

Abstract

Chapter 1 - Introduction. This provides an overview of mental and behavioural disorders (MBD) definitions and current knowledge about MBD in pregnancy. Maternal MBD in pregnancy are often overlooked. Most studies of MBD in pregnancy focused on a single class of MBD. This thesis used linked data from NSW Perinatal Data Collection and the NSW Admitted Patient Data Collection to assess diagnosed MBD in NSW maternities between 2002 and 2006. Chapter 2 – Methods. Describes data linkage, MBD definitions and preliminary data processing. Chapter 3 – Admissions for MBD in pregnancy. A study to compare rates of MBD admissions in pregnancy relative to MBD admissions in a baseline period. Overall, admissions for MBD were lower in early pregnancy (RR 0.71) and higher in late pregnancy (RR 1.91). Drug disorder admissions were more than 3-fold higher in late pregnancy. Schizophrenia admissions increased from early pregnancy and alcohol admissions remained lower throughout pregnancy. Baseline MBD admissions rates were higher for multiparous than primiparous maternities. Chapter 4 – Admissions with MBD in pregnancy. MBD prevalence in pregnancy was 2.4% overall, 1.4% for drug/alcohol disorders (DA) and 1.2% mental disorders (MD). Pregnancy DA prevalence was the same, psychotic disorder prevalence was half, affective disorder a third and anxiety a tenth that of comparable disorders in women of reproductive age. Coexisting MBD ranged from 23.6% for anxiety to 91.5% for sedative disorders. Smokers and residents in outer regional or more remote locations were identified as maternity populations at high risk of MBD. Chapter 5 – Neonatal outcomes. Assessed relative risks of individual classes of MBD on perinatal mortality, preterm birth, small size at birth, neonatal morbidity, and admission to neonatal intensive care (NICU). Adverse outcomes were on average 3- 4-fold higher for MBD relative to no MBD. Effects were universally attenuated by adjustment for smoking and co-existing MBD. Independent effects of opiate and cannabis disorders remained for most adverse neonatal outcomes, but not for schizophrenia or bipolar disorder. Chapter 6 – Discussion and conclusions. This thesis demonstrates the value of linked population data; has added to the evidence for pregnancy as risk for MBD; provided the first comprehensive prevalence estimates of MBD in pregnancy for all maternities in NSW, including both high and low prevalence MBD; provided evidence to support findings elsewhere of an independent association of alcohol, cannabis, or opiate disorder with poor neonatal outcomes, but not for schizophrenia or bipolar disorder.