Integrated care for multi-domain vulnerability during pregnancy: a retrospective cohort study

Abstract

Purpose: Psychosocial risk factors are frequently present in pregnant women and are associated with adverse maternal and neonatal outcomes. Professional guidelines recommend early detection of vulnerability and provision of multidisciplinary care, including an integrated care plan for pregnant women with social factors, such as residing in deprived areas, teenage pregnancy, and psychiatric illness. However, to date, such approach is impeded by lack of data on co-occurrence of vulnerability. Therefore, we aim to describe co-occurrence of psychiatric illness, social factors or substance use during pregnancy.

Methods: A retrospective cohort study of 1002 pregnant women referred for evaluation by a multidisciplinary team because of psychiatric illness, social factors or substance use in a university hospital in a large city in the Netherlands. Data from medical charts between January 2017 and May 2022 were extracted and analyzed by univariate and bivariate analysis.

Results: Multi-domain vulnerability was present in 83% of women and most frequently involved the following patterns: psychiatric illness with social factors and chronic physical illness (24%), psychiatric illness with social factors (14%), social factors with chronic physical illness (13%) and psychiatric illness with chronic physical illness (12%). Single-domain vulnerability was present in 17% of women, involving most frequently social factors (9%) and psychiatric illness (8%).

Conclusion: The majority of women with psychiatric illness, social factors or substance use have multi-domain vulnerability. There is a need for a novel approach to care to address vulnerability in pregnant women.

Keywords: Complex social factors; Integrated approach; Intellectual disability; Psychiatric illness; Psychosocial care; Substance use.

Fig. 1

Development of the integrated care plan. ^aMaternal Fetal Medicine specialist, midwife, obstetric physician assistant, obstetric nurse,^bPsychiatrist, psychiatric nurse, psychiatric physician assistant, ^cNeonatal physician assistant, ^dIf involved internal medicine specialist, or physician assistant (e.g. in case of HIV-infection, gestational diabetes or inborn errors of metabolism), ^eSocial worker

Fig. 2

The Upset Plot: Interacting domains of social factors, psychiatric illness, chronic physical illness, substance use and intellectual disability. The connected dots below show patterns of co-occurrence. The bars show the number of women with that pattern of occurrence

Fig. 3

Heat map of the number of vulnerabilities per domain for all participants: Interacting domains of social factors, psychiatric illness, chronic physical illness, substance use and intellectual disability. The colour grading is used to depict the relative number of reported vulnerabilities per domain, with darker blue indicating more co-occurrence of vulnerabilities