There is increasing concern about the impact of the social-distancing measures, and changes to health and social care service delivery, during the COVID-19 pandemic on mental health and domestic violence and abuse (DVA). Pregnant women were advised to follow additional social distancing measures, increasing their vulnerability with potentially far reaching effects on women and children’s health. Reductions in face-to-face appointments during the pandemic may have affected the ability of healthcare providers to identify and address problems in the perinatal period.
The aim of this study is to determine the impact of the service delivery changes during the COVID-19 pandemic on:
1. Identification of mental illness and DVA during pregnancy
2. Referrals to specialist perinatal mental health services during pregnancy
3. Rates of spontaneous and iatrogenic preterm birth and low birthweight among women with mental illness or DVA
4. Rates of new onset and relapse of mental illness three months after birth
This study utilises pre-existing data linkage between maternity and mental health records in South London from the eLIXIR (early-LIfe data cross-LInkage in Research) research . Electronic healthcare data on two cohorts of women will be extracted: 1) pregnancies booked for antenatal care before the start of the UK social-distancing measures (July-December 2019) and 2) pregnancies booked during the initial social-distancing measures (March-August 2020). An interrupted time-series design, using segmented regression analysis, will be conducted to calculate the differences in the incidence rate perinatal mental health, DVA and alcohol and substance misuse. We will also compare mental health, pregnancy and birth outcomes before, during and after birth. Analysis will be adjusted for potential confounding factors and correlations in the data over time.
The first stage of analysis expected to be published in early 2021 will focus on the identification of mental illness, DVA and referrals to mental health services during pregnancy in both cohorts. Subsequent analyses of birth and postnatal outcomes are expected to be published later in 2021 This study will also establish a birth cohort of women affected by the pandemic during pregnancy, which can be used to identify longer-term risks for future adverse neonatal and child outcomes.
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Wu, Y.-T., et al., Perinatal Depression of Women Along with 2019 Novel Coronavirus Breakout in China.
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Harville, E., X. Xiong, and P. Buekens, Disasters and perinatal health: a systematic review. Obstetrical & gynecological survey, 2010. 65(11): p. 713.
Carson, L. E., Azmi, B., Jewell, A., … Poston, L. (2020). Cohort profile: the eLIXIR Partnership—a maternity–child data linkage for life course research in South London, UK. BMJ Open, 10, e039583.
Oram, S., H. Khalifeh, and L.M. Howard, Violence against women and mental health. The Lancet Psychiatry, 2017. 4(2): p. 159-170.
South London and Maudsley NHS Foundation Trust;
Guys and St Thomas’ NHS Foundation Trust;
King’s College Hospital NHS Foundation Trust
Professor Louise Howard - https://www.kcl.ac.uk/people/louise-howard
Ms Rosanna Hildersley - https://kclpure.kcl.ac.uk/portal/rosanna.hildersley.html