Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia.

Cummins, A; Baird, K; Melov, SJ; Melhem, L; Hilsabeck, C; Hook, M; Elhindi, J; Pasupathy, D

Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia.

Cummins, A Baird, K

Melov, SJ Melhem, L Hilsabeck, C Hook, M Elhindi, J Pasupathy, D

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Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: Women Birth, 2022, pp. S1871-5192(22)00305-5
Issue Date:: 2022-08-05

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Field	Value	Language
dc.contributor.author	Cummins, A
dc.contributor.author	Baird, K https://orcid.org/0000-0003-0142-6962
dc.contributor.author	Melov, SJ
dc.contributor.author	Melhem, L
dc.contributor.author	Hilsabeck, C
dc.contributor.author	Hook, M
dc.contributor.author	Elhindi, J
dc.contributor.author	Pasupathy, D
dc.date.accessioned	2022-12-01T23:48:05Z
dc.date.available	2022-08-02
dc.date.available	2022-12-01T23:48:05Z
dc.date.issued	2022-08-05
dc.identifier.citation	Women Birth, 2022, pp. S1871-5192(22)00305-5
dc.identifier.issn	1871-5192
dc.identifier.issn	1878-1799
dc.identifier.uri	http://hdl.handle.net/10453/164022
dc.description.abstract	BACKGROUND: Perinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions. AIM: To compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth. METHODS: A retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 - 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care. RESULTS: The cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24-0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93-3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10-4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57-1.09). CONCLUSIONS: This evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier BV
dc.relation.ispartof	Women Birth
dc.relation.isbasedon	10.1016/j.wombi.2022.08.002
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.title	Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study, from Australia.
dc.type	Journal Article
utslib.location.activity	Netherlands
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	open_access	*
dc.date.updated	2022-12-01T23:48:04Z
pubs.publication-status	Published online

Abstract:

BACKGROUND: Perinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions. AIM: To compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth. METHODS: A retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 - 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care. RESULTS: The cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24-0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93-3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10-4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57-1.09). CONCLUSIONS: This evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.

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http://hdl.handle.net/10453/164022