Integrated care for multi-domain vulnerability during pregnancy: a retrospective cohort study

Psychosocial risk factors are frequently present in pregnant women and are associated with adverse maternal and neonatal outcomes. Professional guidelines recommend early detection of vulnerability and provision of multidisciplinary care, including an integrated care plan for pregnant women with social factors, such as residing in deprived areas, teenage pregnancy, and psychiatric illness. However, to date, such approach is impeded by lack of data on co-occurrence of vulnerability. Therefore, we aim to describe co-occurrence of psychiatric illness, social factors or substance use during pregnancy.

A retrospective cohort study of 1002 pregnant women referred for evaluation by a multidisciplinary team because of psychiatric illness, social factors or substance use in a university hospital in a large city in the Netherlands. Data from medical charts between January 2017 and May 2022 were extracted and analyzed by univariate and bivariate analysis.

Multi-domain vulnerability was present in 83% of women and most frequently involved the following patterns: psychiatric illness with social factors and chronic physical illness (24%), psychiatric illness with social factors (14%), social factors with chronic physical illness (13%) and psychiatric illness with chronic physical illness (12%). Single-domain vulnerability was present in 17% of women, involving most frequently social factors (9%) and psychiatric illness (8%).

The majority of women with psychiatric illness, social factors or substance use have multi-domain vulnerability. There is a need for a novel approach to care to address vulnerability in pregnant women.