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

Area of Science:

• Perinatal mental health
• Public health
• Social determinants of health

Background:

• Psychosocial risk factors are common in pregnancy and linked to adverse maternal and neonatal outcomes.
• Guidelines advocate for early detection and multidisciplinary care for vulnerable pregnant women.
• Lack of data on the co-occurrence of these vulnerabilities hinders integrated care planning.

Purpose of the Study:

• To investigate the co-occurrence of psychiatric illness, social factors, and substance use during pregnancy.
• To identify patterns of multi-domain vulnerability in pregnant women.
• To inform the development of targeted interventions and care strategies.

Main Methods:

• Retrospective cohort study of 1002 pregnant women referred to a multidisciplinary team.
• Data collected from medical charts between January 2017 and May 2022 at a Dutch university hospital.
• Univariate and bivariate analyses were used to examine the co-occurrence of vulnerabilities.

Main Results:

• 83% of women presented with multi-domain vulnerability.
• Common patterns included psychiatric illness with social factors and chronic physical illness (24%), and psychiatric illness with social factors (14%).
• Single-domain vulnerability was observed in 17% of women, primarily social factors (9%) and psychiatric illness (8%).

Conclusions:

• The majority of pregnant women with psychiatric illness, social factors, or substance use exhibit multi-domain vulnerability.
• A significant need exists for novel care approaches to effectively address complex vulnerabilities in this population.
• Findings underscore the importance of integrated, multidisciplinary care models for pregnant women facing multiple psychosocial challenges.