Perinatal mental health: the role of social inequalities and domestic abuse on maternal outcomes

Perinatal mental health conditions (depression, anxiety disorders, and postpartum psychosis/bi-polar disorder) affect one in four new/expectant mothers. We assessed the impact of social inequalities, sociodemographic factors, domestic abuse and maternal interactions with social services in childhood on mortality and morbidity outcomes in women with these conditions in Northern Ireland (NI).

Methods
We identified a population-based cohort of 179,723 mothers giving birth in NI between 1st January 2010 and 31st December 2022 (301,110 pregnancies). Eight datasets were linked: maternity, death records, prescriptions, hospital episodes/admission/discharges, A&E, mental health inpatient data, social services, and the rateable value of the property of maternal residence during pregnancy. Sociodemographic variables included maternal age, parity, gestational age, single parent family, marital status, employment status, and ethnic group. Domestic abuse was identified from the maternity disclosure variables and A&E data. Maternal morbidity outcomes included mental health medication use and hospital admissions.

Results
We will present the:
•Incidence and prevalence of perinatal mental health conditions occurring during pregnancy and in the first year following birth.
•Sociodemographic and socioeconomic determinants of perinatal mental health conditions and the impact of these on maternal mortality and morbidity outcomes in women with perinatal mental health conditions.
•Incidence and impact of domestic abuse (and associated sociodemographic and socioeconomic risk factors) on maternal mortality and morbidity outcomes in women with perinatal mental health conditions.
•Relationship between maternal interactions with social services in childhood and maternal mortality and morbidity outcomes in women with perinatal mental health conditions.
•How multiple adversity (socioeconomic inequalities, socio-demographic factors, maternal interactions with social services in childhood, and domestic abuse) contributes to maternal mortality and morbidity outcomes in these women.

Conclusion
This is the first population-wide study to investigate how multiple adversity affects mortality and morbidity outcomes in women with perinatal mental health conditions. The impact of this research will enable early effective support and interventions to be implemented to minimise adverse outcomes in this vulnerable population.