The first 100 days after childbirth: cross-sectional study of maternal clinical events and health needs from primary care.

BACKGROUND: The first 100 days after childbirth are important for women recovering from pregnancy and birth. AIM: To describe the most common clinical events or health needs documented in women's primary care records in the first 100 days after childbirth. DESIGN AND SETTING: Cross-sectional study using electronic health records from United Kingdom primary care data. METHOD: We examined the primary care records from childbirth up to 100 days after childbirth of women aged 16-49 years who had given birth to a single live infant 2006-2016 in IMRD. We identified the most common clinical events or health needs based on documented symptoms, diagnoses and medications. We explored how these varied by patient characteristic. RESULTS: We identified 925,712 contacts during the 100 days following 309,573 births. We found that women were most likely to use primary care to have a postnatal visit or check (60.6%), for monitoring (such as a blood pressure reading) (49.9%), and to access contraception (49.7%). Younger women were more likely to have contacts for preventative care compared to older women but were less likely to have contacts for ongoing mental and physical symptoms or conditions, and pre-existing conditions. The highest peak in contacts occurred 42 days after birth, and related to a postnatal check or visit, monitoring a patient and recording lifestyle factors (such as smoking status). CONCLUSION: Primary care services should seek to match the needs of new mothers taking account of a high volume of contacts for a broad range of planned and responsive care following childbirth.

Association of Recent Fatherhood With Antidepressant Treatment Initiation Among Men in the United Kingdom.

Importance: There is some evidence that men may be at higher risk of depression directly following the birth of their child and that approximately 1 in 10 men will experience depression in the year after birth, but less is known about men's antidepressant treatment during this time. Likewise, few direct comparisons have been made with antidepressant treatment in men who have not recently become fathers. Objectives: To determine whether recently having a child was associated with increased odds of antidepressant treatment in men. Design, Setting, and Participants: This cohort study used UK primary care electronic health records from the IQVIA Medical Research Database. Participants included men aged 15 to 55 years who had had a child in the previous year, from January 2007 to December 2016, and compared with up to 5 men who did not have a child in the same calendar year. Data were analyzed from January 2022 to March 2023. Exposure: A record of having a child in the previous year was identified through linked primary care records using a family identification number. Main Outcomes and Measures: The main outcome was antidepressant initiation in the year after childbirth or in the year after this index date for men who did not have a child. Random-effects Poisson regression was used to determine associations of cohort, age group, social deprivation, history of antidepressant treatment, and calendar year with having an antidepressant prescription in the year after index date using prevalence risk rates (PPRs). Results: Analysis included 90 736 men who had had a child in the previous year and 453 632 men in the comparison cohort. Most men in the study (463 879 men [85.2%]) were aged between 25 and 44 years, and there were more men living in the least deprived areas (130 277 men [23.9%]) than the most deprived areas (72 268 men [13.3%]). Overall, 4439 men (4.9%) had at least 1 antidepressant prescription in the year after they had a child, compared with 26 646 men (5.9%) who did not have a child in the same year. However, after adjustment there was no difference in antidepressant treatment between groups (adjusted PRR [aPRR], 1.01; 95% CI, 0.98-1.04). In fathers, those who had recently received antidepressant treatment were much more likely to receive antidepressant treatment after childbirth compared with fathers with no history of antidepressant treatment (aPRR, 32.31; 95% CI, 30.37-34.38). Fathers living in the most deprived areas were 18% more likely to have an antidepressant prescription compared with fathers living in the least deprived areas (aPRR, 1.18; 95% CI, 1.07-1.30). Conclusions and Relevance: These findings suggest that recently having a child was not associated with an increase in antidepressant treatment among men, but previous antidepressant treatment in fathers was strongly associated with treatment after childbirth. Further research is needed to determine whether antidepressant treatment or experiencing depression can be a barrier to fatherhood and whether fatherhood is a barrier to receiving antidepressant treatment.

Postnatal checks and primary care consultations in the year following childbirth: an observational cohort study of 309 573 women in the UK, 2006-2016.

OBJECTIVE: To describe women's uptake of postnatal checks and primary care consultations in the year following childbirth. DESIGN: Observational cohort study using electronic health records. SETTING: UK primary care. PARTICIPANTS: Women aged 16-49 years who had given birth to a single live infant recorded in The Health Improvement Network (THIN) primary care database in 2006-2016. MAIN OUTCOME MEASURES: Postnatal checks and direct consultations in the year following childbirth. RESULTS: We examined 1 427 710 consultations in 309 573 women who gave birth to 241 662 children in 2006-2016. Of these women, 78.7% (243 516) had a consultation at the time of the postnatal check, but only 56.2% (174 061) had a structured postnatal check documented. Teenage women (aged 16-19 years) were 12% less likely to have a postnatal check compared with those aged 30-35 years (incidence rate ratio (IRR) 0.88, 95% CI 0.85 to 0.91) and those living in the most deprived versus least deprived areas were 10% less likely (IRR 0.90, 95% CI 0.88 to 0.92). Women consulted on average 4.8 times per woman per year and 293 049 women (94.7%) had at least one direct consultation in the year after childbirth. Consultation rates were higher for those with a caesarean delivery (7.7 per woman per year, 95% CI 7.7 to 7.8). Consultation rates peaked during weeks 5-10 following birth (11.8 consultations/100 women) coinciding with the postnatal check. CONCLUSIONS: Two in 10 women did not have a consultation at the time of the postnatal check and four in 10 women have no record of receiving a structured postnatal check within the first 10 weeks after giving birth. Teenagers and those from the most deprived areas are among the least likely to have a check. We estimate up to 350 400 women per year in the UK may be missing these opportunities for timely health promotion and to have important health needs identified following childbirth.