Psychiatric disorders and compliance with prenatal care: A 10-year retrospective cohort compared to controls

Inadequate prenatal care has been associated with adverse perinatal outcomes. We sought to compare compliance with prenatal care visits (PCV), oral glucose tolerance test (OGTT) and serum alfa-fetoprotein (aFP) in women with psychiatric disorders (PD) and healthy controls.

Subjects were 5395 women (1043 PD and 4352 controls), members of Clalit Health Services (Tel-Aviv district, Israel), who gave birth during 2004-2014. We used Generalized Estimating Equations with binary-logistic models, considering consecutive pregnancies as repeated measures with unbalanced design. The diagnostic subgroup was the main independent, assessed once with and once without age, socioeconomic status and multiple gestation variables.

Risk for non-compliance with OGTT was increased in women with depression (aOR = 1.4, 95% CI = 1.1-1.7) and schizophrenia (aOR = 1.8, 95% CI = 1.1-2.9), but not anxiety. Risk for non-compliance with aFP was decreased in women with anxiety (aOR = 0.6, 95% CI = 0.5-0.8), but women with depression and schizophrenia did not differ from controls. PD were at risk for both absence of PCV (aOR = 4.6, 95% CI = 2.7-8.0) and high utilization of PCV (>20 visits, aOR = 2.8, 95% CI = 2.1-3.7). Psychopharmacological treatment during pregnancy was associated with high utilization of PCV (OR = 2.2, 95% CI = 1.7-2.9), increased compliance with aFP tests (OR = 1.4, 95% CI = 1.1-1.7) and marginally-significant increased compliance with OGTT (OR = 0.82, 95% CI = 0.67-1.01).

PD under-utilized tests perceived for the wellbeing of the mother (OGTT) and over-utilize tests for the wellbeing of the fetus (aFP). PD exhibited patterns of both very low and very high utilization of PCV. Psychopharmacological treatment during pregnancy may improve some measures of compliance with prenatal care.