The Lancet Public Health’s paper broke new ground in several areas. It made use of a novel method for linking information from mother and baby hospital records, which allowed the association between psychosocial maternal risk factors and infant outcomes to be explored. Previous studies have only been able to look at mother and baby records individually. The paper provides fresh insights for targeting early interventions towards the most vulnerable families.
The team, which included Associate Professor Katie Harron and Professor Ruth Gilbert (both HDR UK Associated Researchers), wanted to explore the relationship between psychosocial risk factors among pregnant women and adverse infant outcomes. The risk factors included teenage motherhood, deprivation, pre-pregnancy hospital admissions for mental health or behavioural conditions, and pre-pregnancy hospital admissions for adversity (including drug or alcohol abuse, violence, and self-harm). Infant outcomes included low birthweight, unplanned admission for injury, or death.
Much of the data they needed is routinely gathered. However, data about mothers and their babies is recorded separately in England. This has prevented researchers from looking at which maternal health factors affect her baby.
Dr Harron developed a probabilistic linkage technique that allowed the NHS England Hospital Episode Statistics (HES) database to be used (without identifying individuals) to connect mothers and babies. This allowed the team to analyse 2,137,103 births from 2010-15.
Babies born to mothers with a psychosocial risk factor (previous birth before 20 years of age, hospital contacts related to adversity or mental health or behavioural conditions, and deprivation history of mental health or behavioural conditions, or adversity) have poorer outcomes than those to mothers without these risk factors. Infants born to mothers with a history of mental health conditions were 124g lighter than those of mothers without these conditions (a similar impact to that of smoking during pregnancy). Risks of preterm birth, injury and death were also substantially higher for these mothers.
Impact and outcomes
The research fills an evidence gap by identifying a group of women and babies at high risk and clearly shows the need for interventions before, during, and after pregnancy. The team hopes its work will influence the current update of the Healthy Child Programme (HCP) for pregnancy and the first five years of life.
The probabilistic linkage techniques developed by Dr Harron (who is based at UCL) also opens the way for further mother and child health research.
Aims and priorities
The study contributed to HDR UK priorities for maximising the impact of health data research in:
- Improving healthy life expectancy for people living with a common disease
- Developing and applying advanced health data science to address major health challenges.
It also relates to its research priorities of:
- Improving public health
- Understanding the causes of diseases
- Better care.
Team and authors
Background: Existing studies evaluating the association between maternal risk factors and specific infant outcomes such as birthweight, injury admissions, and mortality have mostly focused on single risk factors. We aimed to identify routinely recorded psychosocial characteristics of pregnant women most at risk of adverse infant outcomes to inform targeting of early intervention.
Methods: We created a cohort using administrative hospital data (Hospital Episode Statistics) for all births to mothers aged 15–44 years in England, UK, who gave birth on or after April 1, 2010, and who were discharged before or on March 31, 2015. We used generalised linear models to evaluate associations between psychosocial risk factors recorded in hospital records in the 2 years before the 20th week of pregnancy (ie, teenage motherhood, deprivation, pre-pregnancy hospital admissions for mental health or behavioural conditions, and pre-pregnancy hospital admissions for adversity, including drug or alcohol abuse, violence, and self-harm) and infant outcomes (ie, birthweight, unplanned admission for injury, or death from any cause, within 12 months from postnatal discharge).
Findings: Of 2 520 501 births initially assessed, 2 137 103 were eligible and were included in the birth outcome analysis. Among the eligible births, 93 279 (4·4%) were births to teenage mothers (age <20 years), 168 186 (7·9%) were births to previous teenage mothers, 51 312 (2·4%) were births to mothers who had a history of hospital admissions for mental health or behavioural conditions, 58 107 (2·7%) were births to mothers who had a history of hospital admissions for adversity, and 580 631 (27·2%) were births to mothers living in areas of high deprivation. 1 377 706 (64·5%) of births were to mothers with none of the above risk factors. Infants born to mothers with any of these risk factors had poorer outcomes than those born to mothers without these risk factors. Those born to mothers with a history of mental health or behavioural conditions were 124 g lighter (95% CI 114–134 g) than those born to mothers without these conditions. For teenage mothers compared with older mothers, 3·6% (95% CI 3·3–3·9%) more infants had an unplanned admission for injury, and there were 10·2 (95% CI 7·5–12·9) more deaths per 10 000 infants.
Interpretation: Health-care services should respond proactively to pre-pregnancy psychosocial risk factors. Our study demonstrates a need for effective interventions before, during, and after pregnancy to reduce the downstream burden on health services and prevent long-term adverse effects for children.
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