Maternal perinatal anxiety and infant primary care use: a cohort study

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

4D.2

Presenter:

Holly Christina Smith

Twitter:

@ron_direction

Co-authors:

Holly C Smith1, Tamsin Fisher2, Katrina Turner2, Victoria Silverwood2, Tom Kingstone2, Charlotte Archer2, James Bailey2, Jonathan Evans2, David Kessler3, Janine Procter4, Noureen Shivji2, Amy Spruce5, Pensee Wu2, Dahai Yu2 and Irene Petersen1

Author institutions:

1University College London, 2 School of Medicine, Keele University. 3University of Bristol. 4Just Family CIC. 5Keele University (PPIE contributor).

Problem

Perinatal anxiety (PNA) is estimated to affect 21% of women during pregnancy or up to 12 months after birth and can have a negative impact on mothers, their children, and partners. There is a suggestion that PNA is associated with lower rates of vaccinations, decreased access to preventative healthcare, and increased healthcare use in infants; but the results across studies have not been conclusive. The aim of this study was to use linked mother and infant primary care records to investigate if infants had higher primary care use and were less likely to receive planned preventative care after birth if their mother had a record of PNA. We also explored how birth characteristics (such as gestation and birthweight) impacted on this relationship.

Approach

We conducted a cohort study using data from the IQVIA Medical Research Database (IMRD), a large UK primary care electronic health record database. We identified 248,618 mother-infant pairs, where pregnancy started between 1998-2016. PNA was identified through prescriptions, diagnosis, and symptom records during the perinatal period. Infant outcomes included primary care consultation rate, attending a 6-8-week infant check appointment and uptake of the 5-in-1 vaccination. We compared unadjusted rates of infant primary care consultations and used random-effects logistic regression models to analyse other outcomes, comparing children of women with perinatal anxiety to those without.

Findings

Of the 248,618 women, 11,558 (4.7%) had a record of perinatal anxiety. Infants of mothers with perinatal anxiety had on average 1 more primary care consultation/person-year in the year after birth compared to those without (9.7 vs 8.7). Primary care consultation rates were also higher for infants who were born prematurely, were low birth weight or who had low APGAR scores. We found no difference in infant vaccination uptake between mothers with/without PNA in our crude analysis (94.7% vs 95.3%); however, in adjusted analysis, mothers with PNA were more likely to have an infant who was vaccinated (OR: 1.33, 95% CI: 1.20-1.48). There was a small difference in attendance of the 6-8-week infant check between mothers with/without PNA (80.7% vs 82.7%) in crude analysis, in our adjusted analysis mother with PNA were 12% less likely to have a record of an infant check (aOR: 0.88, 95% CI: 0.81-0.95).

Consequences

Overall, our findings across outcome measures presents a mixed picture. It is reassuring that infants of mothers with PNA were more likely to be vaccinated than those with no anxiety; however, we found that these infants were less likely to have a record of a 6-8-week infant check and have slightly higher primary care consultation rates. Future research should consider how infant health has an impact on the relationship between perinatal anxiety and infant healthcare use.

Submitted by:

Holly Smith

Funding acknowledgement:

This study was funded by NIHR School for Primary Care Research (SPCR)