This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Community perinatal mental health teams support women before and during pregnancy, and in the 12 months after giving birth. Researchers found that in areas of the country where teams were available, women who had previous contact with psychiatric services:
- were more likely to access mental health support
- had a lower risk of relapse requiring hospital admission in the year after giving birth.
Secondary findings in areas with teams included a lower risk of premature (early) birth, but a slightly higher risk of stillbirth, child death, and babies with low birthweight. More research is needed to confirm these findings and explore potential reasons.
The researchers say their findings suggest that community perinatal mental health teams improve the mental health of women during and after pregnancy.
More information on perinatal mental health can be found on the NHS website.
The issue: how to support pregnant women with a history of mental illness
Women who have previously had severe mental illness, such as bipolar disorder or severe depression, are at increased risk of relapse after giving birth. A 2016 review showed that many (37%) women with bipolar disorder relapsed after childbirth. Other research suggests that women with a history of mental illness are more likely to give birth prematurely (10%) than other women (7%).
Community perinatal mental health teams were launched in England in 2016 to improve access to mental healthcare for pregnant women. They aim to prevent and treat episodes of mental illness during pregnancy and after birth. The service offers psychological interventions, medication advice, help with bonding with the baby, and emergency referrals to appropriate clinicians. However, there is little research evaluating the service.
This study assessed whether access to community perinatal mental health teams reduced the risk of relapse after birth among women with a history of mental illness. The researchers also looked at pregnancy outcomes.
What’s new?
The study was based on the records of women with a history of mental health illness who gave birth in England from 2016 to 2018. Almost half (31,276) had access to community perinatal mental health teams; the others (39,047) did not. Participants had been in contact with a secondary mental health service in the 10 years before their pregnancy. Women who gave birth to more than one baby were excluded.
The main outcome was the number of women who had a relapse requiring a psychiatric hospital admission or being seen by the crisis resolution team in the year after birth. Researchers found that in areas where community perinatal mental health teams were available:
- more women accessed mental healthcare (32%) than in areas without teams (26%)
- fewer women relapsed (3.6%) than in areas without teams (4.5%).
Fewer women had a preterm birth (10.1%) in areas where the service was available than in areas without teams (11.1%). However, the researchers also found that in areas where community perinatal mental health teams were available:
- stillbirth and infant death was slightly more common (0.5% births) than in areas without teams (0.4%)
- more babies had low birthweight (7.2%) than in areas without teams (6.6%).
Overall, there was no difference in adverse pregnancy outcomes in areas with or without community perinatal mental health teams.
Total mental healthcare costs were £111 higher per woman giving birth to a single baby in areas with teams than areas without (based on 2018/19 costs).
Why is this important?
This study provides evidence that community perinatal mental health teams increase access to mental healthcare and reduce the risk of relapse. Greater access to these teams across the UK could improve mental health outcomes for women during pregnancy and after birth. Community perinatal mental health teams are unique to the UK and the researchers say that other countries could benefit from similar services.
There is no simple explanation for the increased risk of stillbirth, child death, and low birthweight babies in areas with access to teams. The researchers suggest that mental health could sometimes have been prioritised over physical health in women with a history of mental illness.
The researchers caution that the study considered women’s potential access to community perinatal mental health teams; it did not look at whether they actually accessed the service.
What’s next?
The researchers suggest that closer working between community perinatal mental health teams and other maternity services could improve care for pregnant women with a history of mental illness. Mental health services have expanded and are now more embedded in maternity services.
Further research is needed to explore whether community perinatal mental health teams are associated with adverse pregnancy outcomes.
How can I act on this research?
You may be interested to read
This is a summary of: Gurol-Urganci I, and others. Community perinatal mental health teams and associations with perinatal mental health and obstetric and neonatal outcomes in pregnant women with a history of secondary mental health care in England: a national population-based cohort study. Lancet Psychiatry 2024; 11: 174 – 82.
A BBC Women’s Hour podcast and a Guardian article about research related to this study.
Information and support about postnatal depression and perinatal mental health from Mind.
Information on taking part in NIHR research on perinatal mental health.
Funding: NIHR Health and Social Care Delivery Research Programme Commissioned Call.
Conflicts of Interest: None declared.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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